Difference between revisions of "Finger (phalanx) fracture"

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===Pearls===
+
==Background==
 +
*Be wary of avulsion fracture of base of phalanx
 +
**Lateral or medial fracture fragment = collateral ligament avulsion
 +
**Dorsal fracture fragment = extensor tendon avulsion
 +
**Palmar fracture fragment = volar plate avulsion
  
* Be wary of avulsion fx of base of phalanx
+
==Types==
** Lateral or medial fracture fragment = collateral ligament avulsion
+
*[[Proximal Phalanx (Finger) Fracture]]
** Dorsal fracture fragment = extensor tendon avulsion
+
*[[Middle Phalanx (Finger) Fracture]]
** Palmar fracture fragment = volar plate avulsion
+
*[[Distal Phalanx (Finger) Fracture]]
* Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture�
 
  
======
+
==Differential Diagnosis==
 +
{{Hand and finger fractures DDX}}
  
===Proximal Phalanx Fx===
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==Management==
 +
{{General Fracture Management}}
  
* Examination
+
==See Also==
** Examine the phalanx with the fingers in full extension and flexion
+
*[[Hand and Finger Fractures]]
** Assess for malrotation
+
*[[Hand Diagnoses (Main)]]
* 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===
+
==References==
 +
<References/>
  
* Commonly associated with tendon injuries!
+
[[Category:Orthopedics]]
* 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
 
 
 
[[Category:Ortho]]
 

Latest revision as of 02:56, 18 September 2019

Background

  • Be wary of avulsion fracture of base of phalanx
    • Lateral or medial fracture fragment = collateral ligament avulsion
    • Dorsal fracture fragment = extensor tendon avulsion
    • Palmar fracture fragment = volar plate avulsion

Types

Differential Diagnosis

Hand and Finger Fractures

Management

General Fracture Management

See Also

References