Finger (phalanx) fracture: Difference between revisions
(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...") |
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===Pearls=== | ===Pearls=== | ||
* Be wary of avulsion fx of base of phalanx | * Be wary of avulsion fx of base of phalanx | ||
* Lateral or medial fracture fragment = collateral ligament avulsion | ** Lateral or medial fracture fragment = collateral ligament avulsion | ||
* Dorsal fracture fragment = extensor tendon avulsion | ** Dorsal fracture fragment = extensor tendon avulsion | ||
* Palmar fracture fragment = volar plate avulsion | ** Palmar fracture fragment = volar plate avulsion | ||
* Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon | * Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture� | ||
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===Proximal Phalanx Fx=== | ===Proximal Phalanx Fx=== | ||
* 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 | * Imaging | ||
* AP, lateral, oblique | ** AP, lateral, oblique | ||
* Examine for rotation, shortening, angulation | *** Examine for rotation, shortening, angulation | ||
* Treatment | * Treatment | ||
* If requires ortho referral: Radial or ulnar gutter splint | ** If requires ortho referral: Radial or ulnar gutter splint | ||
* Nondisplaced, stable: | ** 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 | *** If the ring finger is involved it should be buddy taped to the little finger | ||
* Displaced or angulated fx | ** Displaced or angulated fx | ||
* Consider closed reduction | *** Consider closed reduction | ||
* After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture) | **** After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)� | ||
* Disposition | * Disposition | ||
* Refer for: | ** Refer for: | ||
* Intraarticular | *** Intraarticular | ||
* Unstable | *** Unstable | ||
* Spiral or oblique fx | **** Spiral or oblique fx | ||
* Condylar fx | **** Condylar fx | ||
* Neck fx | **** Neck fx | ||
* Large avulsion fx | **** Large avulsion fx | ||
* Rotated | *** Rotated | ||
* NO degree of rotation is acceptable following a reduction | **** NO degree of rotation is acceptable following a reduction | ||
* Shortened | *** Shortened | ||
* Significantly angulated | *** Significantly angulated | ||
* Less than | **** Less than 10� may be tolerated | ||
===Middle Phalanx Fx=== | ===Middle Phalanx Fx=== | ||
* Commonly associated with tendon injuries! | * Commonly associated with tendon injuries! | ||
* Examination | * Examination | ||
* Assess PIP, DIP flexion/extension | ** Assess PIP, DIP flexion/extension | ||
* Assess PIP, DIP collateral ligaments (varus/valgus stress) | ** Assess PIP, DIP collateral ligaments (varus/valgus stress) | ||
* Images | * Images | ||
* AP, lateral, oblique | ** AP, lateral, oblique | ||
* Oblique and spiral fractures: evaluate for shortening/malrotation | ** Oblique and spiral fractures: evaluate for shortening/malrotation | ||
* Treatment | * Treatment | ||
* Nondisplaced without angulation: | ** Nondisplaced without angulation: | ||
* Buddy tape to adjacent finger | *** Buddy tape to adjacent finger | ||
* Buddy tape ring finger to little finger | **** Buddy tape ring finger to little finger | ||
* Dorsal or volar finger splint if desire added | *** Dorsal or volar finger splint if desire added protection� | ||
* Displaced or angulated fx | ** Displaced or angulated fx | ||
* Closed reduction | *** Closed reduction | ||
* Adequate reduction: | **** Adequate reduction: | ||
* <1-2mm displacement or shortening | ***** <1-2mm displacement or shortening | ||
* Up to | ***** Up to 10� of angulation | ||
* No amount rotation | ***** No amount rotation | ||
* Followed by ulnar or radial gutter splint | **** Followed by ulnar or radial gutter splint | ||
* Wrist in 20- | ***** Wrist in 20-30� of extension | ||
* MCP joints in 70- | ***** MCP joints in 70-90� of flexion | ||
* PIP and DIP joints flexed 5- | ***** PIP and DIP joints flexed 5-10� | ||
* Decreases the force exerted by the | ****** Decreases the force exerted by the FDS� | ||
* Dispo | * Dispo | ||
* Refer for: | ** Refer for: | ||
* Comminution | *** Comminution | ||
* Malrotation | *** Malrotation | ||
* Intraarticular fx | *** Intraarticular fx | ||
* Displaced or angulated fractures that cannot maintain their reduction | *** Displaced or angulated fractures that cannot maintain their reduction | ||
* Most spiral and oblique fx (usually involve rotation or shortening and are unstable) | *** 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 | * Imaging | ||
* Comminuted tuft fx | ** Comminuted tuft fx | ||
* Stable | *** Stable | ||
* Longitudinal fx | ** Longitudinal fx | ||
* Usually non-displaced and stable | *** Usually non-displaced and stable | ||
* Transverse fx | ** Transverse fx | ||
* Evaluate for angulation/displacement | *** Evaluate for angulation/displacement | ||
* Intraarticular fx | ** Intraarticular fx | ||
* Treatment | * Treatment | ||
* Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx( | ** 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 | *** Do not attempt to reduce comminuted tuft fx� | ||
* Dispo | * Dispo | ||
* Refer for: | ** Refer for: | ||
* Tendon dysfunction | *** Tendon dysfunction | ||
* Nerve dysfunction | *** Nerve dysfunction | ||
* Displacement or angulation | *** Displacement or angulation | ||
* Intraarticular fx | *** Intraarticular fx | ||
==Source== | ==Source== | ||
UpToDate | UpToDate | ||
[[Category:Ortho]] | [[Category:Ortho]] |
Revision as of 21:43, 8 April 2011
Pearls
- 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 Fx
- Examination
- Examine the phalanx with the fingers in full extension and flexion
- Assess for malrotation
- Imaging
- AP, lateral, oblique
- Examine for rotation, shortening, angulation
- AP, lateral, oblique
- 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)�
- Consider closed reduction
- 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� may be tolerated
- Refer for:
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�
- Buddy tape to adjacent finger
- Displaced or angulated fx
- Closed reduction
- Adequate reduction:
- <1-2mm displacement or shortening
- Up to 10� of angulation
- No amount rotation
- Followed by ulnar or radial gutter splint
- Wrist in 20-30� of extension
- MCP joints in 70-90� of flexion
- PIP and DIP joints flexed 5-10�
- Decreases the force exerted by the FDS�
- Adequate reduction:
- Closed reduction
- Nondisplaced without angulation:
- 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)
- Refer for:
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
- Comminuted tuft 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�
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx(
- Dispo
- Refer for:
- Tendon dysfunction
- Nerve dysfunction
- Displacement or angulation
- Intraarticular fx
- Refer for:
Source
UpToDate