Middle phalanx (finger) fracture
Background
- Commonly associated with tendon injuries!
Examination
- Assess PIP, DIP flexion/extension
- Assess PIP, DIP collateral ligaments (varus/valgus stress)
Images
- AP, lateral, oblique
- Oblique and spiral fractures: evaluate for shortening/malrotation
Differential Diagnosis
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Nondisplaced without angulation
- Buddy tape to adjacent finger
- Buddy tape ring finger to little finger
- Dorsal or volar Finger Splint if desire added protection
Displaced or angulated fracture
- Closed reduction
- Adequate reduction:
- <1-2mm displacement or shortening
- Up to 10 degrees of angulation
- No amount rotation
- Followed by Ulnar Gutter Splint or Radial Gutter Splint
- Wrist in 20-30 degrees of extension
- MCP joints in 70-90 degrees of flexion
- PIP and DIP joints flexed 5-10 degrees
- Decreases the force exerted by the FDS
- Adequate reduction:
Disposition
- Refer for:
- Comminution
- Malrotation
- Intraarticular fracture
- Displaced or angulated fractures that cannot maintain their reduction
- Most spiral and oblique fracture (usually involve rotation or shortening and are unstable)
See Also
- Finger (Phalanx) Fracture
- Hand Diagnoses (Main)
References
UpToDate
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