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===
 
  
 
* 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 rupture
+
* Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture�
=== ===
 
  
 +
======
  
 
===Proximal Phalanx Fx===
 
===Proximal Phalanx Fx===
 
  
 
* 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: Consider buddy taping the injured finger to an adjacent finger
+
** 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 10º may be tolerated  
+
**** Less than 10� may be tolerated
 
  
 
===Middle Phalanx Fx===
 
===Middle Phalanx Fx===
 
  
 
* 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 protection 
+
*** 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 10º of angulation
+
***** 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 20-30º of extension
+
***** Wrist in 20-30� of extension
* MCP joints in 70-90º of flexion
+
***** MCP joints in 70-90� of flexion
* PIP and DIP joints flexed 5-10º
+
***** PIP and DIP joints flexed 5-10�
* Decreases the force exerted by the FDS
+
****** 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)
 
  
 
===Distal Phalanx Fx===
 
===Distal Phalanx Fx===
 
  
 
* 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 fx
+
*** 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
 
  
 
==Source==
 
==Source==
 
  
 
UpToDate
 
UpToDate
 
 
 
  
 
[[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
  • 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)�
  • 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

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�
    • 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�
  • 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)

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
  • 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�
  • Dispo
    • Refer for:
      • Tendon dysfunction
      • Nerve dysfunction
      • Displacement or angulation
      • Intraarticular fx

Source

UpToDate