Diferencia entre revisiones de «Distal phalanx (finger) fracture»

Revisión actual - 22:39 22 mar 2023

Background

Fracture of distal portion of distal phalanx is also known as a "Tuft fracture"
Hand: finger slammed in door
Foot: stubbed toe or dropped a heavy object

Finger (phalanx) fracture types

Clinical Features

Pain and/or swelling of the digit
Sensation usually intact
- Pain on palpation

Differential Diagnosis

Mallet finger

Distal Finger (Including Nail) Injury

Hand and Finger Fracture Types

Evaluation

Tuft's fracture

Distal phalanx fracture concerning for Mallet finger

Imaging

Hand and/or finger x-rays

Diagnosis

Comminuted tuft fracture
- Stable
Longitudinal fracture
- Usually non-displaced and stable
Transverse fracture
- Evaluate for angulation/displacement
Intraarticular fracture
Evaluate additionally for:
- Tendon damage
- Second 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

Nonoperative
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
  - Most cases
- Eval nail bed
  - Is a Nailbed laceration underneath possible?
- Digital blocks can be helpful for evaluation and management
- Do not attempt to reduce comminuted tuft fracture
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

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) as long as:

Fracture is at distal phalanx (i.e. tuft fracture)
Intact digital arteries
Clean wound

Disposition

Refer for:
- Tendon dysfunction
- Nerve dysfunction
- Displacement or angulation
- Intraarticular fracture
- Complex involving Nailbed laceration

References

Authors:

@@ Línea 1: / Línea 1: @@
 ==Background==
+*Fracture of distal portion of distal phalanx is also known as a "Tuft fracture"
+*Hand: finger slammed in door
+*Foot: stubbed toe or dropped a heavy object
-==Clinical Presentation==
+{{Finger fracture types}}
-===Examination===
-* Evaluate for tendon damage
-===Imaging===
+==Clinical Features==
-* Comminuted tuft fx
+*Pain and/or swelling of the digit
-** Stable
+*Sensation usually intact
-* Longitudinal fx
+**Pain on palpation
-** Usually non-displaced and stable
-* Transverse fx
-** Evaluate for angulation/displacement
-* Intraarticular fx
 ==Differential Diagnosis==
+*[[Mallet finger]]
 {{DDX distal finger}}
+{{Hand and finger fractures DDX}}
+==Evaluation==
+[[File:Tufts_fracture.jpg|thumb|Tuft's fracture]]
+[[File:MalletFinger.png |thumb|Distal phalanx fracture concerning for [[Mallet finger]]]]
+===Imaging===
+*Hand and/or finger x-rays
+===Diagnosis===
+*Comminuted tuft fracture
+**Stable
+*Longitudinal fracture
+**Usually non-displaced and stable
+*Transverse fracture
+**Evaluate for angulation/displacement
+*Intraarticular fracture
+*Evaluate additionally for:
+**Tendon damage
+**Second 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===
+*Nonoperative
+**Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
+***Most cases
+**Eval nail bed
+***Is a [[Nailbed laceration]] underneath possible?
+**[[Digital block]]s can be helpful for evaluation and management
+**Do not attempt to reduce comminuted tuft fracture
+*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]]
-==Treatment==
+===Prophylactic Antibiotics===
-* Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
+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:
-** Do not attempt to reduce comminuted tuft fx
+*Fracture is at distal phalanx (i.e. tuft fracture)
+*Intact digital arteries
+*Clean wound
 ==Disposition==
-* Refer for:
+*Refer for:
-** Tendon dysfunction
+**Tendon dysfunction
-** Nerve dysfunction
+**Nerve dysfunction
-** Displacement or angulation
+**Displacement or angulation
-** Intraarticular fx
+**Intraarticular fracture
+**Complex involving [[Nailbed laceration]]
 ==See Also==
 *[[Finger (Phalanx) Fracture]]
 *[[Hand Diagnoses (Main)]]
+*[[Nailbed laceration]]
+*[[Subungual hematoma]]
-==Source==
+==References==
-UpToDate
+<references/>
-[[Category:Ortho]]
+[[Category:Orthopedics]]