Middle phalanx (finger) fracture

Background

  • 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

Differential Diagnosis

Hand and Finger Fractures

Management

General Fracture Management

Nondisplaced without angulation

Displaced or angulated fracture

  • Closed reduction
    • Adequate reduction:
      • <1-2mm displacement or shortening
      • Up to 10 degrees of angulation
      • No amount rotation
    • Followed by Ulnar Gutter Splint 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

Disposition

  • Refer for:
    • Comminution
    • Malrotation
    • Intraarticular fracture
    • Displaced or angulated fractures that cannot maintain their reduction
    • Most spiral and oblique fracture (usually involve rotation or shortening and are unstable)

See Also

References

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