Proximal phalanx (finger) fracture

Background

The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity[1]
Extensor tendons and interosseous muscles commonly causes volar angulation[1]

Clinical Features

Finger pain

Differential Diagnosis

Hand and Finger Fractures

Evaluation

Physical

Examine the phalanx with the fingers in full extension and flexion
Assess for malrotation

Imaging

AP, lateral, oblique
- Examine for rotation, shortening, angulation

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, stable

Consider buddy taping the injured finger to an adjacent finger
- If the ring finger is involved it should be buddy taped to the little finger
- Dorsal or volar Finger Splint if desire added protection

Displaced or angulated fracture

Consider closed reduction
- After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)

Immobilization

If requires ortho referral: Radial gutter splint or ulnar gutter splint[1]

Disposition

Refer for:
- Intraarticular
- Unstable
  - Spiral or oblique fracture
  - Condylar fracture
  - Neck fracture
  - Large avulsion fracture
- Rotated
  - NO degree of rotation is acceptable following a reduction
- Shortened
- Significantly angulated
  - Less than 10 degrees may be tolerated

See Also

Finger (Phalanx) Fracture
Hand Diagnoses (Main)

References

German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.

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