Difference between revisions of "Finger (phalanx) fracture"

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Revision as of 21:54, 8 April 2011

Background

  • 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 degrees 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 degrees of angulation
          • No amount rotation
        • Followed by ulnar or radial gutter splint
          • Wrist in 20-30 degrees of extension
          • MCP joints in 70-90 degrees of flexion
          • PIP and DIP joints flexed 5-10 degrees
            • 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