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