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. Splint types
    1. Aluminum splint (U-shaped padded aluminum splint, fingertip guard or volar finger splint)
  3. Open Fracture
    1. Extensive Cleaning and Debridement
    2. Consider Antibiotics such as Cephalexin (may not be necessary)
    3. Tetanus Prophylaxis
    4. Splinting for 3-4 weeks (e.g. Aluminum splint)
  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. Transverse (horizontal) Fracture
    1. Occurs with direct Trauma or compression
    2. Splinting for 3-4 weeks (e.g. Aluminum splint)
    3. Refer for significant displacement not reducible with closed reduction
  6. Oblique Fractures (diagonal Fracture line)
    1. Occurs with shearing or twisting injury
    2. Splinting for 3-4 weeks (e.g. Aluminum splint)
    3. Refer for significant displacement not reducible with closed reduction
  7. Vertical Fractures
    1. Occurs with direct compression or torsional force
    2. Splinting for 3-4 weeks (e.g. Aluminum splint)
    3. Refer for significant displacement not reducible with closed reduction
  8. Base nonarticular Fracture
    1. Occurs with high energy, direct Trauma to the fingertip
    2. Immobilize with aluminum splint (U-shaped padded aluminum splint, fingertip guard or volar finger splint)
      1. Splint in full extension for at least 3-4 weeks
    3. Refer only for severe displacement or angulation not reducible with closed reduction
  9. Base DIP joint Intraarticular Fracture
    1. Occurs with high energy, direct Trauma to the fingertip
    2. Refer for severe displacement/angulation (not reducible with closed reduction) or if >1/3 of joint surface involved
    3. Reduce Fracture
    4. Immobilize with aluminum splint (U-shaped padded aluminum splint, fingertip guard or volar finger splint)
      1. Splint in full extension for at least 3-4 weeks, up to 4-6 weeks
      2. Reevaluate after Splinting
  10. Nails
    1. Be alert for nail bed injuries; treat appropriately
    2. Repair Nail Bed Lacerations
    3. Subungual Hematoma (Nail Trephination) treatment may be palliative
  11. 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
  12. 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. Hilgefort (2025) Am Fam Physician 112(1): 47-54 [PubMed]
  8. Wang (2001) Am Fam Physician 63(10):1961-66 [PubMed]

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