Finger (phalanx) fracture
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)
- 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
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
- 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
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
See Also
Source
UpToDate