II. Epidemiology
- Phalanx Fractures account for 10% of all Fractures and 1-2% of all emergency department visits
- Distal Phalanx Fractures are most common
- Most commonly caused by work injury or Sports Injury
III. Types: Phalanx Fractures
IV. Types: Finger Avulsion Fractures (Tendon Ruptures)
- DIP Extensor Tendon Avulsion (Mallet Finger, Drop Finger, Baseball Finger)
- DIP Flexor Tendon Avulsion (Jersey Finger, Flexor Digitorum Profundus Avulsion)
- PIP Extensor Tendon Avulsion (Central Slip Extensor Tendon Injury, Boutonniere Deformity)
- PIP Flexor Tendon Avulsion (Volar Plate Injury, Jammed Finger, Swan-Neck deformity)
V. Types: Dislocations
VI. Exam
- See Hand Exam (includes Hand Neurovascular Exam)
- Injury exam mantra: "joint above, joint below, circulation, motor function and Sensation, skin and compartments"
- Evaluate for flexor and extensor tendon integrity at MCP, PIP and DIP joints
- Evaluate for rotational alignment (see below)
- Evaluate for open Fracture
VII. XRay
- Hand or finger xray
- Anteroposterior, lateral and oblique views
- Rotational abnormalities may appear on lateral xray as variation in phalanx shaft widths
VIII. Management: General Principles of Hand Fracture Management
- See Epiphyseal Fracture (for Fractures in Children)
- See Interphalangeal Dislocation
- See specific Finger Avulsion Fractures (listed above)
- Nerve Block for any manipulation required at time of Splinting
- Correct angular malalignment and rotation
- Fracture reduction for all unstable, oblique, angulated or displaced Fractures
- Obtain post-reduction xrays after reduction and Splinting
- Axes of all flexed fingers should point toward Scaphoid Bone or radial styloid (thenar eminence)
- Fracture reduction for all unstable, oblique, angulated or displaced Fractures
-
Splinting
- Splint in position of moderate flexion
- Avoid Splinting fingers in extension (esp MCP)
- Avoid over-immobilization (leads to Joint Stiffness and longer recovery)
- Stable, non-displaced Phalanx Fractures may be buddy taped with early protected ROM
- Gutter splint (Ulnar Gutter Splint or Radial Gutter Splint)
- Splint in intrinsic position (30 degrees wrist extension, 90 degrees MCP flexion, IPs in extension)
- Splint in position of moderate flexion
- Evaluate peri-articular Fractures for avulsed tendon
- Avulsed fragments are often attached to a tendon or ligament
- Outpatient follow-up within 5-7 days
- Reevaluate for angulation, rotation or translation
IX. Management: Open Reduction and Internal Fixation (ORIF)
X. References
- Perkins (2020) Crit Dec Emerg Med 34(10): 10-1
- Childress (2022) Am Fam Physician 105(6): 631-9 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 157229003, 263212004, 208429005, 18171007, 405817008 |
| Dutch | gebroken vinger, falanx; fractuur vinger, fractuur; falanx vinger, fractuur; hand, falanx, fractuur; vinger, hand; fractuur, falanx, vinger{s}; fractuur |
| French | Doigt fracturé |
| German | gebrochener Finger |
| Italian | Dito fratturato |
| Portuguese | Dedo da mão fracturado |
| Spanish | Dedo fracturado, fractura de falange de mano (trastorno), fractura de falange de la mano (trastorno), fractura de falange de mano, fractura de falange de la mano, fractura de dedo de la mano, fractura de la falange de dedo de la mano (trastorno), fractura de la falange de dedo de la mano |
| Japanese | 指の骨折, ﾕﾋﾞﾉｺｯｾﾂ |
| English | fracture of phalanges of hand (diagnosis), fracture of phalanges of hand, Fractured finger, fingers fractured, fracture finger, Fracture;finger(s), fingers fracture, finger fracture, phalanx fracture hand, phalanx fracture of finger, fracture fingers, fracture phalanx hand, finger fractures, fracture of phalanx of finger, fracture of phalanx of finger (diagnosis), fracture of phalanges of finger, Fracture of finger (disorder), Finger fracture, Fracture of finger, Fracture of phalanx of finger, Fracture of phalanx of finger (disorder), Fracture of phalanx of hand (disorder), Fracture of phalanx of hand, finger(s); fracture, fracture; finger, fracture; hand, phalanx, fracture; phalanx fingers, hand; fracture, phalanx, phalanx; fracture finger, Fracture of finger, NOS, Fracture of phalanx of finger, NOS, Finger Fracture, fractured finger |
| Czech | Zlomený prst |
| Hungarian | Ujjtörés |
Ontology: Fracture of hand (C0435632)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 20511007 |
| Italian | Frattura della mano |
| Dutch | gebroken hand, fractuur; hand, hand; fractuur, handbreuk |
| French | Main cassée, Fracture de la main |
| German | gebrochene Hand, Fraktur der Hand |
| Portuguese | Mão partida, Fractura da mão |
| Spanish | Mano rota, fractura de mano (trastorno), fractura de la mano, fractura de mano, fractura de un hueso de la mano, fractura de la mano (trastorno), Fractura de la mano |
| Japanese | 手骨折, 手の骨折, ﾃﾉｺｯｾﾂ, ﾃｺｯｾﾂ, ｼｭｺｯｾﾂ |
| Czech | Zlomenina ruky, Zlomená ruka |
| English | Broken hand, Hand fracture, bones fractures hand, fracture hand, broken hand, fractures hand, Fracture;hand, fractures hands, hand broken, fracture of hand, hand fracture, bone fractures hand, of hand fracture, broken hands, fracture of hand (diagnosis), fracture of hand bone, fracture of hand bone (diagnosis), Fracture of bone of hand, Fracture of hand (disorder), Fracture of hand bone, Fracture of hand, fracture; hand, hand; fracture, Fracture of hand bone, NOS, Fracture of hand, NOS, Hand Fracture, fractured hand |
| Hungarian | Törött kéz, Kéztörés |
Ontology: finger(s); fracture phalanx (except thumb) (C1411008)
| Concepts | Injury or Poisoning (T037) |
| English | finger(s); fracture phalanx (except thumb) |
| Dutch | vinger{s}; fractuur falanx (behalve duim) |
