Edited by Jonathan Lans and CJ Nessralla - 7/1/2021
Descriptors
Phalanx Fractures
Exam Pearls
Upper extremity neurovascular exam
Assess cascade and tenodesis – note presence of scissoring and angular deformity
Mallet finger: DIP flexed at rest, unable to extend DIP.
Tuft (distal phalanx) fracture: assess for nailbed laceration, large subungual hematoma, evaluate for Seymour fracture (particularly in pediatric population)
Workup
Radiographs:
AP, lateral, oblique hand and specific finger.
Other imaging: None. CT scans in rare instances (only if requested by fellow/attending).
Labs: None
Other: None
Management
Hand consults should be staffed with attending/fellow prior to definitive management.
PIP/MCP dislocations need reduction by recreating deformity, maintaining articular surface contact, and translation. Straight longitudinal traction can convert to irreducible dislocation!
Nailbed repair in tuft fractures with nailbed laceration
Weight-bearing and range of motion: NWB UE, ROMAT elbow.
Type of immobilization: Volar resting splint in intrinsic plus (less restrictive immobilization may be considered as dictated by fellow/attending)
Admission or discharge status: 2-4 days clinic (operative versus nonoperative management decision made on outpatient basis in clinic)
Anticoagulation: None
Antibiotics: Open fx: Ancef IV in the ED, then a course of Keflex.
Surgical Indications
Absolute: Unstable fracture pattern, displaced intraarticular fracture. More than 50% joint involvement and/or joint subluxation.