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Phalanx Fractures Hand
From WikiSM
(Redirected from Phalanx Fractures (Hand))
Contents
Other Names
- Finger Fracture
- Distal Phalanx Fracture
- Middle Phalanx Fracture
- Proximal Phalanx Fracture
Background
- This page refers to fractures of the 2-3 bones of the finger referred to as Phalanx
History
Epidemiology
- Approximately 10% of all fractures (need citation)
Pathophysiology
- General
- Very common, however less common than Metacarpal Fractures
- Can be proximal, middle, distal phalanx
- Can occur base, neck, shaft or head
- May be intra- or extra-articular
- Some may not even seek medical attention if non displaced
Etiology
- Crush
- Sports
- Machinery
- Falls
Risk Factors
- Male
Differential Diagnosis
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
- History
- Characterize mechanism of injury
- Location of pain, swelling should clue you into injury pattern
- Physical Exam: Physical Examination Hand
- Inspection may reveal ecchymosis, swelling, deformity
- Important to exclude rotational deformity, open wounds
- Palpation reveals focal tenderness of the affected bone(s)
- Range of motion is often reduced
- Assess for "scissoring" of digits which suggests rotational component
- Radial and ulnar pulse most often normal, check 2-point discrimination
Evaluation
Radiographs
- Standard Radiographs Hand
- First line imaging in all suspected phalanx fractures
- Generally characterizes lesion well
Ultrasound
- Ultrasound can be used to diagnose phalanx fractures
- Exact role in diagnosis compared to XR is not well defined
MRI/CT
- Generally not needed
- Rarely, may be indicated in complex or surgical cases
Classification
- Head Fractures
- Type I (stable with no displacement)
- Type II (unstable unicondylar)
- Type III (unstable bicondylar or comminuted)
Management
Non-operative
- Indications
- Most phalanx fractures are managed nonoperatively
- Generally includes extra-articular, < 10° angulation, < 2 mm shortening, no rotational deformity
- Distal Phalanx
- Splinting for non-displaced fractures
- Immobilize PIP and DIP joints
- Can buddy tape
- Proximal Phalanx
- Needs to cover Metacarpophalangeal Joint
- Non-displaced or displaced fractures which have been reduced
- Intra-articular fractures can be nonoperatively managed if non displaced
Operative
- Indications
- Extra-articular, > 10° angulation, > 2 mm shortening, or with rotational deformity
- Displaced intra-articular fractures
- Unstable or irreducible fracture pattern
- Open fractures
- Technique
- Often uses K-wires or ORIF
- Traction for comminuted fractures
Rehab and Return to Play
Rehabilitation
- Post operative care at discretion of surgeon
Return to Play/ Work
- RTP varies widely
- Largely depends on sport and position
- In general, anticipate 4-6 weeks before returning
- In some sports, can consider playing in a splint or cast if needed
Complications and Prognosis
Prognosis
- Most patients will have good outcomes
Complications
- Nailbed Injuries
- Fracture-dislocations
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/