Distal Phalanx Fracture

Aka: Distal Phalanx Fracture, Tuft Fracture

1. Mechanism
   1. Usually blunt trauma or crush injury to finger tip
   2. Stable because soft tissue support of septae
2. Types: Fracture
   1. Longitudinal Fracture
   2. Transverse Fracture
   3. Comminuted Fracture
3. Signs
   1. Swollen and painful distal digit
   2. Examination points
      1. Distal interphalangeal joint (DIP) range of motion
      2. Distal Two Point Discrimination
4. Associated Conditions
   1. Nail Bed Laceration
   2. Subungual Hematoma
5. Radiology
   1. XRay of digit (AP, lateral, oblique)
6. Management
   1. Open Fracture
      1. Extensive Cleaning and debridement
      2. Consider antibiotics such as Cephalexin (may not be necessary)
      3. Tetanus prophylaxis
      4. Splinting for 4-6 weeks (e.g. Aluminum splint)
   2. DIP joint Fracture
      1. Refer only for severe displacement or angulation
      2. Reduce Fracture
      3. Immobilize with aluminum splint
         1. Splint in full extension for 4-6 weeks
         2. Reevaluate after Splinting
   3. Closed Tuft Fracture
      1. Reduction for significant angulation or displacement
      2. Splinting 2-4 weeks of DIP joint only
         1. Provides comfort and digit protection
      3. Early range of motion and strengthening Exercises
   4. Nails
      1. Be alert for nail bed injuries; treat appropriately
      2. Repair Nail Bed Lacerations
      3. Subungual Hematoma treatment may be palliative
   5. Palliative measures
      1. First 72 hours
         1. Tube gauze compression dressing
         2. Ice and elevation
      2. After 72 hours
         1. Warm soaks
         2. Gentle finger range of motion
7. Management: Anticipatory guidance
   1. Finger tip hypersensitivity, pain or numbness for up to 6 months
   2. Anticipate rapid recovery
8. Management: Orthopedics referral Indications (rarely needed)
   1. Profound Soft Tissue Injury
   2. Unstable or difficult Fracture reduction
   3. Intra-articular Fracture over 1/3 of articular surface
   4. Consider for open Tuft Fracture
9. Complications
   1. Painful Fracture nonunion
   2. Osteomyelitis
10. References
    1. Brandenburg (1996) Consultant p.331-340
    2. Calmbach (1996) Lecture in Minneapolis
    3. Dvorak (1996) Lecture in Minneapolis
    4. Lillegard (1996) Lecture in Minneapolis
    5. Wang (2001) Am Fam Physician 63(10):1961-66