Difference between revisions of "Finger (phalanx) fracture"

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

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