Proximal phalanx (finger) fracture: Difference between revisions
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*The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity<ref name="Hand and wrist emergencies">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.</ref> | *The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity<ref name="Hand and wrist emergencies">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.</ref> | ||
*Extensor tendons and interosseous muscles commonly causes volar angulation<ref name="Hand and wrist emergencies">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.</ref> | *Extensor tendons and interosseous muscles commonly causes volar angulation<ref name="Hand and wrist emergencies">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.</ref> | ||
{{Finger fracture types}} | |||
==Clinical Features== | ==Clinical Features== | ||
* | *Pain and/or swelling of the digit | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Nondisplaced, stable=== | ===Nondisplaced, stable=== | ||
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*Consider closed reduction | *Consider closed reduction | ||
**After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture) | **After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture) | ||
===Immobilization=== | |||
*If requires ortho referral: [[Radial gutter splint]] or [[ulnar gutter splint]]<ref name="Hand and wrist emergencies">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.</ref> | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 22:42, 22 March 2023
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]
Finger (phalanx) fracture types
- Proximal Phalanx (Finger) Fracture
- Middle Phalanx (Finger) Fracture
- Distal Phalanx (Finger) Fracture
Clinical Features
- Pain and/or swelling of the digit
Differential Diagnosis
Hand and Finger Fracture Types
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
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
- If requires ortho referral: Radial gutter splint or ulnar gutter splint[1]
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