Difference between revisions of "Finger (phalanx) fracture"
(Created page with "===Pearls=== * Be wary of avulsion fx of base of phalanx * Lateral or medial fracture fragment = collateral ligament avulsion * Dorsal fracture fragment = extensor tendon avuls...") |
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===Pearls=== | ===Pearls=== | ||
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* Be wary of avulsion fx of base of phalanx | * Be wary of avulsion fx of base of phalanx | ||
| − | * Lateral or medial fracture fragment = collateral ligament avulsion | + | ** Lateral or medial fracture fragment = collateral ligament avulsion |
| − | * Dorsal fracture fragment = extensor tendon avulsion | + | ** Dorsal fracture fragment = extensor tendon avulsion |
| − | * Palmar fracture fragment = volar plate avulsion | + | ** Palmar fracture fragment = volar plate avulsion |
| − | * Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon | + | * Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture� |
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| + | ====== | ||
===Proximal Phalanx Fx=== | ===Proximal Phalanx Fx=== | ||
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* Examination | * Examination | ||
| − | * Examine the phalanx with the fingers in full extension and flexion | + | ** Examine the phalanx with the fingers in full extension and flexion |
| − | * Assess for malrotation | + | ** Assess for malrotation |
* Imaging | * Imaging | ||
| − | * AP, lateral, oblique | + | ** AP, lateral, oblique |
| − | * Examine for rotation, shortening, angulation | + | *** Examine for rotation, shortening, angulation |
* Treatment | * Treatment | ||
| − | * If requires ortho referral: Radial or ulnar gutter splint | + | ** If requires ortho referral: Radial or ulnar gutter splint |
| − | * Nondisplaced, stable: | + | ** Nondisplaced, stable:� Consider buddy taping the injured finger to an adjacent finger |
| − | * If the ring finger is involved it should be buddy taped to the little finger | + | *** If the ring finger is involved it should be buddy taped to the little finger |
| − | * Displaced or angulated fx | + | ** Displaced or angulated fx |
| − | * Consider closed reduction | + | *** Consider closed reduction |
| − | * After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture) | + | **** After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)� |
* Disposition | * Disposition | ||
| − | * Refer for: | + | ** Refer for: |
| − | * Intraarticular | + | *** Intraarticular |
| − | * Unstable | + | *** Unstable |
| − | * Spiral or oblique fx | + | **** Spiral or oblique fx |
| − | * Condylar fx | + | **** Condylar fx |
| − | * Neck fx | + | **** Neck fx |
| − | * Large avulsion fx | + | **** Large avulsion fx |
| − | * Rotated | + | *** Rotated |
| − | * NO degree of rotation is acceptable following a reduction | + | **** NO degree of rotation is acceptable following a reduction |
| − | * Shortened | + | *** Shortened |
| − | * Significantly angulated | + | *** Significantly angulated |
| − | * Less than | + | **** Less than 10� may be tolerated |
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===Middle Phalanx Fx=== | ===Middle Phalanx Fx=== | ||
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* Commonly associated with tendon injuries! | * Commonly associated with tendon injuries! | ||
* Examination | * Examination | ||
| − | * Assess PIP, DIP flexion/extension | + | ** Assess PIP, DIP flexion/extension |
| − | * Assess PIP, DIP collateral ligaments (varus/valgus stress) | + | ** Assess PIP, DIP collateral ligaments (varus/valgus stress) |
* Images | * Images | ||
| − | * AP, lateral, oblique | + | ** AP, lateral, oblique |
| − | * Oblique and spiral fractures: evaluate for shortening/malrotation | + | ** Oblique and spiral fractures: evaluate for shortening/malrotation |
* Treatment | * Treatment | ||
| − | * Nondisplaced without angulation: | + | ** Nondisplaced without angulation: |
| − | * Buddy tape to adjacent finger | + | *** Buddy tape to adjacent finger |
| − | * Buddy tape ring finger to little finger | + | **** Buddy tape ring finger to little finger |
| − | * Dorsal or volar finger splint if desire added | + | *** Dorsal or volar finger splint if desire added protection� |
| − | * Displaced or angulated fx | + | ** Displaced or angulated fx |
| − | * Closed reduction | + | *** Closed reduction |
| − | * Adequate reduction: | + | **** Adequate reduction: |
| − | * <1-2mm displacement or shortening | + | ***** <1-2mm displacement or shortening |
| − | * Up to | + | ***** Up to 10� of angulation |
| − | * No amount rotation | + | ***** No amount rotation |
| − | * Followed by ulnar or radial gutter splint | + | **** Followed by ulnar or radial gutter splint |
| − | * Wrist in 20- | + | ***** Wrist in 20-30� of extension |
| − | * MCP joints in 70- | + | ***** MCP joints in 70-90� of flexion |
| − | * PIP and DIP joints flexed 5- | + | ***** PIP and DIP joints flexed 5-10� |
| − | * Decreases the force exerted by the | + | ****** Decreases the force exerted by the FDS� |
| − | * Dispo | + | * Dispo |
| − | * Refer for: | + | ** Refer for: |
| − | * Comminution | + | *** Comminution |
| − | * Malrotation | + | *** Malrotation |
| − | * Intraarticular fx | + | *** Intraarticular fx |
| − | * Displaced or angulated fractures that cannot maintain their reduction | + | *** Displaced or angulated fractures that cannot maintain their reduction |
| − | * Most spiral and oblique fx (usually involve rotation or shortening and are unstable) | + | *** Most spiral and oblique fx (usually involve rotation or shortening and are unstable) |
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===Distal Phalanx Fx=== | ===Distal Phalanx Fx=== | ||
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* Examination | * Examination | ||
| − | * Evaluate for tendon damage | + | ** Evaluate for tendon damage |
* Imaging | * Imaging | ||
| − | * Comminuted tuft fx | + | ** Comminuted tuft fx |
| − | * Stable | + | *** Stable |
| − | * Longitudinal fx | + | ** Longitudinal fx |
| − | * Usually non-displaced and stable | + | *** Usually non-displaced and stable |
| − | * Transverse fx | + | ** Transverse fx |
| − | * Evaluate for angulation/displacement | + | *** Evaluate for angulation/displacement |
| − | * Intraarticular fx | + | ** Intraarticular fx |
* Treatment | * Treatment | ||
| − | * Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx( | + | ** Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx( |
| − | * Do not attempt to reduce comminuted tuft | + | *** Do not attempt to reduce comminuted tuft fx� |
* Dispo | * Dispo | ||
| − | * Refer for: | + | ** Refer for: |
| − | * Tendon dysfunction | + | *** Tendon dysfunction |
| − | * Nerve dysfunction | + | *** Nerve dysfunction |
| − | * Displacement or angulation | + | *** Displacement or angulation |
| − | * Intraarticular fx | + | *** Intraarticular fx |
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==Source== | ==Source== | ||
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UpToDate | UpToDate | ||
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[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 21:43, 8 April 2011
Pearls
- Be wary of avulsion fx of base of phalanx
- Lateral or medial fracture fragment = collateral ligament avulsion
- Dorsal fracture fragment = extensor tendon avulsion
- Palmar fracture fragment = volar plate avulsion
- Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture�
==
Proximal Phalanx Fx
- Examination
- Examine the phalanx with the fingers in full extension and flexion
- Assess for malrotation
- Imaging
- AP, lateral, oblique
- Examine for rotation, shortening, angulation
- AP, lateral, oblique
- Treatment
- If requires ortho referral: Radial or ulnar gutter splint
- Nondisplaced, stable:� Consider buddy taping the injured finger to an adjacent finger
- If the ring finger is involved it should be buddy taped to the little finger
- Displaced or angulated fx
- Consider closed reduction
- After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)�
- Consider closed reduction
- Disposition
- Refer for:
- Intraarticular
- Unstable
- Spiral or oblique fx
- Condylar fx
- Neck fx
- Large avulsion fx
- Rotated
- NO degree of rotation is acceptable following a reduction
- Shortened
- Significantly angulated
- Less than 10� may be tolerated
- Refer for:
Middle Phalanx Fx
- Commonly associated with tendon injuries!
- Examination
- Assess PIP, DIP flexion/extension
- Assess PIP, DIP collateral ligaments (varus/valgus stress)
- Images
- AP, lateral, oblique
- Oblique and spiral fractures: evaluate for shortening/malrotation
- Treatment
- Nondisplaced without angulation:
- Buddy tape to adjacent finger
- Buddy tape ring finger to little finger
- Dorsal or volar finger splint if desire added protection�
- Buddy tape to adjacent finger
- Displaced or angulated fx
- Closed reduction
- Adequate reduction:
- <1-2mm displacement or shortening
- Up to 10� of angulation
- No amount rotation
- Followed by ulnar or radial gutter splint
- Wrist in 20-30� of extension
- MCP joints in 70-90� of flexion
- PIP and DIP joints flexed 5-10�
- Decreases the force exerted by the FDS�
- Adequate reduction:
- Closed reduction
- Nondisplaced without angulation:
- Dispo
- Refer for:
- Comminution
- Malrotation
- Intraarticular fx
- Displaced or angulated fractures that cannot maintain their reduction
- Most spiral and oblique fx (usually involve rotation or shortening and are unstable)
- Refer for:
Distal Phalanx Fx
- Examination
- Evaluate for tendon damage
- Imaging
- Comminuted tuft fx
- Stable
- Longitudinal fx
- Usually non-displaced and stable
- Transverse fx
- Evaluate for angulation/displacement
- Intraarticular fx
- Comminuted tuft fx
- Treatment
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx(
- Do not attempt to reduce comminuted tuft fx�
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx(
- Dispo
- Refer for:
- Tendon dysfunction
- Nerve dysfunction
- Displacement or angulation
- Intraarticular fx
- Refer for:
Source
UpToDate