Distal phalanx (finger) fracture - Revision history

Rossdonaldson1: /* Background */

2023-03-22T22:39:55Z

Background

← Older revision		Revision as of 22:39, 22 March 2023
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	*Hand: finger slammed in door		*Hand: finger slammed in door
	*Foot: stubbed toe or dropped a heavy object		*Foot: stubbed toe or dropped a heavy object

			{{Finger fracture types}}

	==Clinical Features==		==Clinical Features==

2023-03-22T22:22:16Z

Evaluation

← Older revision		Revision as of 22:22, 22 March 2023
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	==Evaluation==		==Evaluation==
			[[File:Tufts_fracture.jpg\|thumb\|Tuft's fracture]]
	[[File:MalletFinger.png \|thumb\|Distal phalanx fracture concerning for [[Mallet finger]]]]		[[File:MalletFinger.png \|thumb\|Distal phalanx fracture concerning for [[Mallet finger]]]]

	===Imaging===		===Imaging===
	*Hand ~~Xrays to rule out additional fractures~~		*Hand and/or finger x-rays
	*Comminuted tuft fracture~~[[File:Tufts_fracture.jpg\|thumb\|Tuft's fracture]]~~
			===Diagnosis===
			*Comminuted tuft fracture
	**Stable		**Stable
	*Longitudinal fracture		*Longitudinal fracture
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	**Evaluate for angulation/displacement		**Evaluate for angulation/displacement
	*Intraarticular fracture		*Intraarticular fracture

	~~===Diagnosis===~~
	*Evaluate additionally for:		*Evaluate additionally for:
	**Tendon damage		**Tendon damage

2023-03-22T22:21:08Z

Examination

← Older revision		Revision as of 22:21, 22 March 2023
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	{{Hand and finger fractures DDX}}		{{Hand and finger fractures DDX}}

	==~~Examination~~==		==Evaluation==
	*Evaluate for tendon damage		[[File:MalletFinger.png \|thumb\|Distal phalanx fracture concerning for [[Mallet finger]]]]
	*Always look for ~~a second fracture~~

	===Imaging===		===Imaging===
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	**Evaluate for angulation/displacement		**Evaluate for angulation/displacement
	*Intraarticular fracture		*Intraarticular fracture

			===Diagnosis===
			*Evaluate additionally for:
			**Tendon damage
			**Second fracture

	==Management==		==Management==

2023-03-22T22:18:48Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
			*[[Mallet finger]]
	{{DDX distal finger}}		{{DDX distal finger}}
	{{Hand and finger fractures DDX}}		{{Hand and finger fractures DDX}}

2020-03-26T17:26:52Z

Prophylactic Antibiotics

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	===Prophylactic Antibiotics===		===Prophylactic Antibiotics===
	Controversial but in general, prophylactic antibiotics are indicated for grossly contaminated open wounds, and can be considered in high risk patients (ex. diabetics, peripheral artery disease). Otherwise, NOT indicated in open distal phalanx fracture (aka tuft fracture)		Controversial but in general, prophylactic antibiotics are indicated for grossly contaminated open wounds, and can be considered in high risk patients (ex. diabetics, peripheral artery disease). Otherwise, NOT indicated in open distal phalanx fracture (aka tuft fracture) as long as:
	*Fracture is at distal phalanx (i.e. tuft fracture)		*Fracture is at distal phalanx (i.e. tuft fracture)
	*Intact digital arteries		*Intact digital arteries

2020-03-26T17:26:20Z

General Fracture Management

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	===General Fracture Management===		===General Fracture Management===
	Acute pain management		*Acute pain management
	Open fractures (excluding distal phalanx fractures) require immediate IV antibiotics and urgent surgical washout		*Open fractures (excluding distal phalanx fractures) require immediate IV antibiotics and urgent surgical washout
	Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention		*Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention

	===Specific Management===		===Specific Management===

2020-03-24T21:39:44Z

Management

← Older revision		Revision as of 21:39, 24 March 2020
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	==Management==		==Management==
	{{General Fracture Management}}
			===General Fracture Management===
			Acute pain management
			Open fractures (excluding distal phalanx fractures) require immediate IV antibiotics and urgent surgical washout
			Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention

	===Specific Management===		===Specific Management===
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	===Prophylactic Antibiotics===		===Prophylactic Antibiotics===
	~~Prophylactic~~ antibiotics are NOT indicated ~~despite~~ open ~~phalangeal finger~~ fracture ~~if:~~		Controversial but in general, prophylactic antibiotics are indicated for grossly contaminated open wounds, and can be considered in high risk patients (ex. diabetics, peripheral artery disease). Otherwise, NOT indicated in open distal phalanx fracture (aka tuft fracture)
	*~~Fractures~~ is ~~metacarpophalangeal joint~~ (i.e. ~~Tuft~~ fracture)		*Fracture is at distal phalanx (i.e. tuft fracture)
	*Intact digital arteries		*Intact digital arteries
			*Clean wound

	==Disposition==		==Disposition==

2019-09-18T02:59:09Z

Management

← Older revision		Revision as of 02:59, 18 September 2019
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	==Management==		==Management==
			{{General Fracture Management}}

			===Specific Management===
	*Nonoperative		*Nonoperative
	**Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx		**Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
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	**Eval nail bed		**Eval nail bed
	***Is a [[Nailbed laceration]] underneath possible?		***Is a [[Nailbed laceration]] underneath possible?
	**Digital ~~blocks~~ can be helpful for evaluation and management		**[[Digital block]]s can be helpful for evaluation and management
	**Do not attempt to reduce comminuted tuft fracture		**Do not attempt to reduce comminuted tuft fracture
	*Call Hand or Ortho (institution dependent) for complex finger injuries		*Call Hand or Ortho (institution dependent) for complex finger injuries

2017-11-16T20:57:44Z

Management

← Older revision		Revision as of 20:57, 16 November 2017
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	*Call Hand or Ortho (institution dependent) for complex finger injuries		*Call Hand or Ortho (institution dependent) for complex finger injuries
	**[[Nailbed laceration]] with distal phalanx fractures can be complicated and result in an [[open fracture]]		**[[Nailbed laceration]] with distal phalanx fractures can be complicated and result in an [[open fracture]]

			===Prophylactic Antibiotics===
			Prophylactic antibiotics are NOT indicated despite open phalangeal finger fracture if:
			*Fractures is metacarpophalangeal joint (i.e. Tuft fracture)
			*Intact digital arteries

	==Disposition==		==Disposition==

2017-10-27T16:27:19Z

Management

← Older revision		Revision as of 16:27, 27 October 2017
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	**Do not attempt to reduce comminuted tuft fracture		**Do not attempt to reduce comminuted tuft fracture
	*Call Hand or Ortho (institution dependent) for complex finger injuries		*Call Hand or Ortho (institution dependent) for complex finger injuries
	**[[Nailbed laceration]] with distal phalanx fractures can be complicated and result in open ~~fractures~~		**[[Nailbed laceration]] with distal phalanx fractures can be complicated and result in an [[open fracture]]

	==Disposition==		==Disposition==