Distal phalanx (finger) fracture

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 Features

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

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and Finger Fractures

Examination

Evaluate for tendon damage
Always look for a second fracture

Imaging

Hand Xrays to rule out additional fractures
Comminuted tuft fracture
Tuft's fracture
- Stable
Longitudinal fracture
- Usually non-displaced and stable
Transverse fracture
- Evaluate for angulation/displacement
Intraarticular 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

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