Finger (phalanx) fracture: Difference between revisions
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== | ==Background== | ||
* 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 | ||
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* 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== | |||
* Examination | * Examination | ||
** Examine the phalanx with the fingers in full extension and flexion | ** Examine the phalanx with the fingers in full extension and flexion | ||
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**** Less than 10 degrees may be tolerated | **** Less than 10 degrees may be tolerated | ||
==Middle Phalanx Fx== | |||
* Commonly associated with tendon injuries! | * Commonly associated with tendon injuries! | ||
* Examination | * Examination | ||
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*** 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== | |||
* Examination | * Examination | ||
** Evaluate for tendon damage | ** Evaluate for tendon damage |
Revision as of 21:45, 8 April 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 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 degrees 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 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
- 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
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