II. Mechanism
IV. Signs
- Swollen, Bruised and painful distal digit
- Examination points
- Distal interphalangeal joint (DIP) range of motion
- Distal Two Point Discrimination
V. Associated Conditions
VI. Imaging
- XRay of Digit (AP, lateral, oblique)
VII. Management
- See Phalanx Fracture
- 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 (Nail Trephination) 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
- Inability to flex or extend the joint
- Loss of distal Sensation (esp. thumb, index and middle finger)
- Consider for open Tuft Fracture
X. Complications
- Painful Fracture nonunion
- Osteomyelitis
- Chronic fingertip hyperesthesia
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
- Childress (2022) Am Fam Physician 105(6): 631-9 [PubMed]
- Wang (2001) Am Fam Physician 63(10):1961-66 [PubMed]
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Related Studies
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 36778005 |
| English | Fracture distal phalanx finger, fracture of distal phalanx of finger (diagnosis), fracture of finger distal phalanx, fracture of distal phalanx of finger, Fracture of distal phalanx of finger, Fracture of distal phalanx of finger (disorder) |
| Spanish | fractura de falange distal de dedo de la mano, fractura de la falange distal de dedo de la mano, fractura de la falange distal de un dedo de la mano, fractura de falange distal de dedo de la mano (trastorno), fractura de la falange distal de un dedo de la mano (trastorno) |
