Proximal phalanx (finger) fracture

Background

  • The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity[1]
  • Extensor tendons and interosseous muscles commonly causes volar angulation[1]

Clinical Features

  • Finger pain

Differential Diagnosis

Hand and Finger Fractures

Evaluation

Physical

  • Examine the phalanx with the fingers in full extension and flexion
  • Assess for malrotation

Imaging

  • AP, lateral, oblique
    • Examine for rotation, shortening, angulation

Management

General Fracture Management

  • Acute pain management
  • Open fractures require immediate IV antibiotics and urgent surgical washout
  • Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
  • Consider risk for compartment syndrome
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

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
    • Dorsal or volar Finger Splint if desire added protection

Displaced or angulated fracture

  • Consider closed reduction
    • After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)

Immobilization

Disposition

  • Refer for:
    • Intraarticular
    • Unstable
      • Spiral or oblique fracture
      • Condylar fracture
      • Neck fracture
      • Large avulsion fracture
    • Rotated
      • NO degree of rotation is acceptable following a reduction
    • Shortened
    • Significantly angulated
      • Less than 10 degrees may be tolerated

See Also

References

  1. 1.0 1.1 1.2 German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.