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 Fracture==
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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===
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==Differential Diagnosis==
* AP, lateral, oblique
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{{Hand and finger fractures DDX}}
** Examine for rotation, shortening, angulation
 
  
===Treatment===
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==Management==
* If requires ortho referral: Radial or ulnar gutter splint
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{{General Fracture Management}}
* 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===
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==See Also==
* Refer for:
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*[[Hand and Finger Fractures]]
** Intraarticular
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*[[Hand Diagnoses (Main)]]
** 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 Fracture==
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==References==
* Commonly associated with tendon injuries!
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<References/>
  
===Examination===
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[[Category:Orthopedics]]
* 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
 
 
 
[[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