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Distal phalanx (finger) fracture
From WikEM
Contents
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
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
- Stable
- Longitudinal fracture
- Usually non-displaced and stable
- Transverse fracture
- Evaluate for angulation/displacement
- Intraarticular fracture
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
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
- Call Hand or Ortho (institution dependent) for complex finger injuries
- Nailbed laceration with distal phalanx fractures can be complicated and result in open fractures
Disposition
- Refer for:
- Tendon dysfunction
- Nerve dysfunction
- Displacement or angulation
- Intraarticular fracture
- Complex involving Nailbed laceration
