We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Phalanx Fractures Hand

From WikiSM
Jump to: navigation, search

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


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

Minimally displaced 4th middle phalanx fracture

Radiographs

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
  • 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


See Also


References


Created by:
John Kiel on 26 June 2019 22:44:40
Authors:
Last edited:
14 May 2022 23:33:57
Categories:
Trauma | Osteology | Finger | Hand | Fractures