Finger (phalanx) fracture

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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
  • 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