Orthopedics Book

Cardiovascular Medicine


Distal Phalanx Fracture

Aka: Distal Phalanx Fracture, Tuft Fracture
  1. See Also
    1. Phalanx Fracture
    2. DIP Extensor Tendon Avulsion (Mallet Finger, Drop Finger, Baseball Finger)
    3. DIP Flexor Tendon Avulsion (Jersey Finger, Flexor Digitorum Profundus Avulsion)
    4. DIP Dislocation
  2. Mechanism
    1. Usually blunt Trauma or crush injury to finger tip
    2. Stable Fracture due to soft tissue support of septae
  3. Types: Fracture
    1. Longitudinal Fracture
    2. Transverse Fracture
    3. Comminuted Fracture
  4. Signs
    1. Swollen, Bruised and painful distal digit
    2. Examination points
      1. Distal interphalangeal joint (DIP) range of motion
      2. Distal Two Point Discrimination
  5. Associated Conditions
    1. Nail Bed Laceration
    2. Subungual Hematoma
  6. Imaging
    1. XRay of Digit (AP, lateral, oblique)
  7. 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
  8. Management: Anticipatory guidance
    1. Finger tip Hypersensitivity, pain or numbness for up to 6 months
    2. Anticipate rapid recovery
  9. 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
  10. Complications
    1. Painful Fracture nonunion
    2. Osteomyelitis
    3. Chronic fingertip hyperesthesia
  11. 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]

Fracture of distal phalanx of finger (C0272696)

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)
Derived from the NIH UMLS (Unified Medical Language System)

You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree