II. Mechanism
- Usually blunt Trauma or crush injury to finger tip
- Stable because soft tissue support of septae
IV. Signs
- Swollen and painful distal digit
- Examination points
- Distal interphalangeal joint (DIP) range of motion
- Distal Two Point Discrimination
V. Associated Conditions
VI. Radiology
- XRay of digit (AP, lateral, oblique)
VII. Management
- Open Fracture
- Extensive Cleaning and debridement
- Consider antibiotics such as Cephalexin (may not be necessary)
- Tetanus prophylaxis
- Splinting for 4-6 weeks (e.g. Aluminum splint)
- DIP joint Fracture
- Closed Tuft Fracture
- Nails
- Be alert for nail bed injuries; treat appropriately
- Repair Nail Bed Lacerations
- Subungual Hematoma treatment may be palliative
- Palliative measures
- First 72 hours
- Tube gauze compression dressing
- Ice and elevation
- After 72 hours
- Warm soaks
- Gentle finger range of motion
- First 72 hours
- Seymour Fracture (skeletally immature children)
VIII. Management: Anticipatory guidance
- Finger tip hypersensitivity, pain or numbness for up to 6 months
- Anticipate rapid recovery
IX. Management: Orthopedics referral Indications (rarely needed)
- Profound Soft Tissue Injury
- Unstable or difficult Fracture reduction
- Intra-articular Fracture over 1/3 of articular surface
- Consider for open Tuft Fracture
X. Complications
- Painful Fracture nonunion
- Osteomyelitis
XI. References
- Brandenburg (1996) Consultant p.331-340
- Calmbach (1996) Lecture in Minneapolis
- Dvorak (1996) Lecture in Minneapolis
- Lillegard (1996) Lecture in Minneapolis
- Lin, Gajendran and Orman in Herbert (2016) EM:Rap 16(11): 7-8
- Wang (2001) Am Fam Physician 63(10):1961-66 [PubMed]
