Distal Phalanx Fracture

Aka: Distal Phalanx Fracture, Tuft Fracture

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II. Mechanism

  1. Usually blunt Trauma or crush injury to finger tip
  2. Stable Fracture due to soft tissue support of septae

III. Types: Fracture

  1. Longitudinal Fracture
  2. Transverse Fracture
  3. Comminuted Fracture

IV. Signs

  1. Swollen, Bruised and painful distal digit
  2. Examination points
    1. Distal interphalangeal joint (DIP) range of motion
    2. Distal Two Point Discrimination

V. Associated Conditions

  1. Nail Bed Laceration
  2. Subungual Hematoma

VI. Imaging

  1. XRay of Digit (AP, lateral, oblique)

VII. Management

  1. See Phalanx Fracture
  2. 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)
  3. DIP joint Fracture
    1. Refer only for severe displacement or angulation
    2. Reduce Fracture
    3. Immobilize with aluminum splint (U-shaped padded aluminum splint, fingertip guard or volar finger splint)
      1. Splint in full extension for 4-6 weeks
      2. Reevaluate after Splinting
  4. 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
  5. Nails
    1. Be alert for nail bed injuries; treat appropriately
    2. Repair Nail Bed Lacerations
    3. Subungual Hematoma (Nail Trephination) treatment may be palliative
  6. 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. Seymour Fracture (skeletally immature children)
    1. Displaced distal phalanx physeal Fracture in children with nail bed injury
    2. Tissue may become interposed in Fracture
    3. Risk of growth arrest, nail plate deformity
    4. Consult orthopedics if Seymour Fracture suspected

VIII. Management: Anticipatory guidance

  1. Finger tip Hypersensitivity, pain or numbness for up to 6 months
  2. Anticipate rapid recovery

IX. 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. Inability to flex or extend the joint
  5. Loss of distal Sensation (esp. thumb, index and middle finger)
  6. Consider for open Tuft Fracture

X. Complications

  1. Painful Fracture nonunion
  2. Osteomyelitis
  3. Chronic fingertip hyperesthesia

XI. 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. Lin, Gajendran and Orman in Herbert (2016) EM:Rap 16(11): 7-8
  6. Childress (2022) Am Fam Physician 105(6): 631-9 [PubMed]
  7. Wang (2001) Am Fam Physician 63(10):1961-66 [PubMed]

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