Orthopedics Book

Cardiovascular Medicine

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Hand Fracture

Aka: Hand Fracture, Finger Fracture, Phalanx Fracture, Finger Avulsion Fracture
  1. See Also
    1. Interphalangeal Dislocation
    2. Scaphoid Fracture
    3. Forearm Fracture
  2. Epidemiology
    1. Phalanx Fractures account for 10% of all Fractures and 1-2% of all emergency department visits
    2. Distal Phalanx Fractures are most common
    3. Most commonly caused by work injury or Sports Injury
  3. Types: Phalanx Fractures
    1. Distal Phalanx Fracture
    2. Middle Phalanx Fracture
    3. Proximal Phalanx Fracture
    4. Metacarpal Fracture
    5. Boxer's Fracture
  4. Types: Finger Avulsion Fractures (Tendon Ruptures)
    1. DIP Extensor Tendon Avulsion (Mallet Finger, Drop Finger, Baseball Finger)
    2. DIP Flexor Tendon Avulsion (Jersey Finger, Flexor Digitorum Profundus Avulsion)
    3. PIP Extensor Tendon Avulsion (Central Slip Extensor Tendon Injury, Boutonniere Deformity)
    4. PIP Flexor Tendon Avulsion (Volar Plate Injury, Jammed Finger, Swan-Neck deformity)
  5. Types: Dislocations
    1. Dorsal PIP Dislocation
    2. Lateral PIP Dislocation
    3. Volar PIP Dislocation
    4. DIP Dislocation
    5. IP Joint Dislocation at Thumb
    6. Metacarpal-Phalangeal Dislocation
  6. Exam
    1. See Hand Exam (includes Hand Neurovascular Exam)
    2. Injury exam mantra: "joint above, joint below, circulation, motor function and Sensation, skin and compartments"
    3. Evaluate for flexor and extensor tendon integrity at MCP, PIP and DIP joints
    4. Evaluate for rotational alignment (see below)
    5. Evaluate for open Fracture
  7. XRay
    1. Hand or finger xray
      1. Anteroposterior, lateral and oblique views
      2. Rotational abnormalities may appear on lateral xray as variation in phalanx shaft widths
  8. Management: General Principles of Hand Fracture Management
    1. See Epiphyseal Fracture (for Fractures in Children)
    2. See Interphalangeal Dislocation
    3. See specific Finger Avulsion Fractures (listed above)
    4. Nerve Block for any manipulation required at time of Splinting
      1. See Digital Nerve Block
      2. See Hand and Wrist Regional Anesthesia
    5. Correct angular malalignment and rotation
      1. Fracture reduction for all unstable, oblique, angulated or displaced Fractures
        1. Obtain post-reduction xrays after reduction and Splinting
      2. Axes of all flexed fingers should point toward Scaphoid Bone or radial styloid (thenar eminence)
        1. OrthoHandPositionFistToScaphoid.jpg
    6. Splinting
      1. Splint in position of moderate flexion
        1. Avoid Splinting fingers in extension (esp MCP)
      2. Avoid over-immobilization (leads to Joint Stiffness and longer recovery)
        1. Stable, non-displaced Phalanx Fractures may be buddy taped with early protected ROM
      3. Gutter splint (Ulnar Gutter Splint or Radial Gutter Splint)
        1. Splint in intrinsic position (30 degrees wrist extension, 90 degrees MCP flexion, IPs in extension)
    7. Evaluate peri-articular Fractures for avulsed tendon
      1. Avulsed fragments are often attached to a tendon or ligament
    8. Outpatient follow-up within 5-7 days
      1. Reevaluate for angulation, rotation or translation
  9. Management: Open Reduction and Internal Fixation (ORIF)
    1. Indications
      1. Malrotation >10 degrees
      2. Unstable displaced intra-articular Fractures
        1. if >25-30% of joint surface involved
    2. Advantages
      1. Avoid excessive manipulation
      2. Avoids prolonged Splinting
  10. References
    1. Perkins (2020) Crit Dec Emerg Med 34(10): 10-1
    2. Childress (2022) Am Fam Physician 105(6): 631-9 [PubMed]

Fracture of phalanx of hand (C0272694)

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, ユビノコッセツ
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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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


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


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