Middle phalanx (finger) fracture

Background

• Commonly associated with tendon injuries!

Examination

• Assess PIP, DIP flexion/extension
• Assess PIP, DIP collateral ligaments (varus/valgus stress)

Images

• AP, lateral, oblique
• Oblique and spiral fractures: evaluate for shortening/malrotation

Differential Diagnosis

Hand and Finger Fractures

• Non-thumb metacarpal fractures
  • Head
  • Neck
  • Shaft
  • Base
  • Boxer's fracture
• Thumb fracture
• Finger (Phalanx) Fracture
  • Proximal
  • Middle
  • Distal

Management

• Nondisplaced without angulation:
  • Buddy tape to adjacent finger
    • Buddy tape ring finger to little finger
  • Dorsal or volar Finger Splint if desire added protection
• Displaced or angulated fracture
  • Closed reduction
    • Adequate reduction:
      • <1-2mm displacement or shortening
      • Up to 10 degrees of angulation
      • No amount rotation
    • Followed by Ulnar Gutter Splint or Radial Gutter Splint
      • Wrist in 20-30 degrees of extension
      • MCP joints in 70-90 degrees of flexion
      • PIP and DIP joints flexed 5-10 degrees
        • Decreases the force exerted by the FDS

Disposition

• Refer for:
  • Comminution
  • Malrotation
  • Intraarticular fracture
  • Displaced or angulated fractures that cannot maintain their reduction
  • Most spiral and oblique fracture (usually involve rotation or shortening and are unstable)

See Also

• Finger (Phalanx) Fracture
• Hand Diagnoses (Main)

References

UpToDate

Authors

Ross Donaldson, Neil Young, Daniel Ostermayer