Difference between revisions of "Finger (phalanx) fracture"

Line 6: Line 6:
 
* Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture
 
* Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture
  
==Proximal Phalanx Fx==
+
==Proximal Phalanx Fracture==
* Examination
+
===Examination===
** Examine the phalanx with the fingers in full extension and flexion
+
* Examine the phalanx with the fingers in full extension and flexion
** Assess for malrotation
+
* 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 10 degrees may be tolerated
 
  
==Middle Phalanx Fx==
+
===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 Fracture==
 
* Commonly associated with tendon injuries!
 
* Commonly associated with tendon injuries!
* Examination
+
 
** Assess PIP, DIP flexion/extension
+
===Examination===
** Assess PIP, DIP collateral ligaments (varus/valgus stress)
+
* Assess PIP, DIP flexion/extension
* Images
+
* Assess PIP, DIP collateral ligaments (varus/valgus stress)
** AP, lateral, oblique
+
 
** Oblique and spiral fractures: evaluate for shortening/malrotation
+
===Images===
* Treatment
+
* AP, lateral, oblique
** Nondisplaced without angulation:
+
* Oblique and spiral fractures: evaluate for shortening/malrotation
*** Buddy tape to adjacent finger
+
 
**** Buddy tape ring finger to little finger
+
===Treatment===
*** Dorsal or volar finger splint if desire added protection
+
* Nondisplaced without angulation:
** Displaced or angulated fx
+
** Buddy tape to adjacent finger
*** Closed reduction
+
*** Buddy tape ring finger to little finger
**** Adequate reduction:
+
** Dorsal or volar finger splint if desire added protection
***** <1-2mm displacement or shortening
+
* Displaced or angulated fx
***** Up to 10 degrees of angulation
+
** Closed reduction
***** No amount rotation
+
*** Adequate reduction:
**** Followed by ulnar or radial gutter splint
+
**** <1-2mm displacement or shortening
***** Wrist in 20-30 degrees of extension
+
**** Up to 10 degrees of angulation
***** MCP joints in 70-90 degrees of flexion
+
**** No amount rotation
***** PIP and DIP joints flexed 5-10 degrees
+
*** Followed by ulnar or radial gutter splint
****** Decreases the force exerted by the FDS
+
**** Wrist in 20-30 degrees of extension
* Dispo
+
**** MCP joints in 70-90 degrees of flexion
** Refer for:
+
**** PIP and DIP joints flexed 5-10 degrees
*** Comminution
+
***** Decreases the force exerted by the FDS
*** Malrotation
+
 
*** Intraarticular fx
+
===Dispo===
*** Displaced or angulated fractures that cannot maintain their reduction
+
* Refer for:
*** Most spiral and oblique fx (usually involve rotation or shortening and are unstable)
+
** 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==
 
==Distal Phalanx Fx==
* Examination
+
===Examination===
** Evaluate for tendon damage
+
* Evaluate for tendon damage
* Imaging
+
 
** Comminuted tuft fx
+
===Imaging===
*** Stable
+
* Comminuted tuft fx
** Longitudinal fx
+
** Stable
*** Usually non-displaced and stable
+
* Longitudinal fx
** Transverse fx
+
** Usually non-displaced and stable
*** Evaluate for angulation/displacement
+
* 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
 
** 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==
 
==Source==

Revision as of 18:39, 14 July 2011

Background

  • Be wary of avulsion fx of base of phalanx
    • Lateral or medial fracture fragment = collateral ligament avulsion
    • 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

Proximal Phalanx Fracture

Examination

  • 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 10 degrees may be tolerated

Middle Phalanx Fracture

  • 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 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