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Distal Phalanx FractureAka: Tuft Fracture

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  1. Mechanism
    1. Usually blunt trauma or crush injury to finger tip
    2. Stable because soft tissue support of septae
  2. Fracture Types
    1. Longitudinal Fracture
    2. Transverse Fracture
    3. Comminuted Fracture
  3. Signs
    1. Swollen and painful distal digit
    2. Examination points
      1. Distal interphalangeal joint (DIP) range of motion
      2. Distal Two Point Discrimination
  4. Associated Conditions
    1. Nail Bed Laceration
    2. Subungual Hematoma
  5. Radiology
    1. XRay of digit (AP, lateral, oblique)
  6. Management
    1. Open Fracture
      1. Extensive Cleaning and debridement
      2. Consider antibiotics (may not be necessary)
      3. Tetanus prophylaxis
      4. Splinting for 4-6 weeks (e.g. Aluminum splint)
    2. DIP joint Fracture
      1. Refer only for severe displacement or angulation
      2. Reduce Fracture
      3. Immobilize with aluminum splint
        1. Splint in full extension for 4-6 weeks
        2. Reevaluate after splinting
    3. Closed Fracture
      1. Reduction for significant angulation or displacement
      2. Splinting 2-4 weeks
        1. Provides comfort and digit protection
    4. Nails
      1. Be alert for nail bed injuries; treat appropriately
      2. Repair Nail Bed Lacerations
      3. Subungual Hematoma treatment may be palliative
    5. 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. Complications
    1. Painful Fracture nonunion
    2. Osteomyelitis
  8. Anticipatory guidance
    1. Finger tip hypersensitivity for months later
    2. Anticipate rapid recovery
  9. 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. Consider for open tuft Fracture
  10. 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. Wang (2001) Am Fam Physician 63(10):1961

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