Difference between revisions of "Finger (phalanx) fracture"

(Created page with "===Pearls=== * Be wary of avulsion fx of base of phalanx * Lateral or medial fracture fragment = collateral ligament avulsion * Dorsal fracture fragment = extensor tendon avuls...")
 
(See Also)
 
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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
  
 +
==Types==
 +
*[[Proximal Phalanx (Finger) Fracture]]
 +
*[[Middle Phalanx (Finger) Fracture]]
 +
*[[Distal Phalanx (Finger) Fracture]]
  
* Be wary of avulsion fx of base of phalanx
+
==Differential Diagnosis==
* Lateral or medial fracture fragment = collateral ligament avulsion
+
{{Hand and finger fractures DDX}}
* 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
 
=== ===
 
  
 +
==Management==
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{{General Fracture Management}}
  
===Proximal Phalanx Fx===
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==See Also==
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*[[Hand and Finger Fractures]]
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*[[Hand Diagnoses (Main)]]
  
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==References==
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<References/>
  
* Examination
+
[[Category:Orthopedics]]
* 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 10º 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 10º of angulation
 
* No amount rotation
 
* Followed by ulnar or radial gutter splint
 
* Wrist in 20-30º of extension
 
* MCP joints in 70-90º of flexion
 
* PIP and DIP joints flexed 5-10º
 
* 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