Distal Phalanx Fracture 816.02

synonyms:

Distal Phalanx Fracture ICD-9

  • 816.02(closed),
  • 816.12(open)
  • multiple sites = 816.03(closed), 816.13(open)

Distal Phalanx Fracture Etiology / Epidemiology / Natual History

  • Common, especially injuries involving the thumb, index and middle fingers.

Distal Phalanx Fracture Anatomy

  • DIP extension is provided by the the conjoined lateral bands which insert into the base of the distal phalanx
  • Conjoined lateral bands are made up of the lateral slips of the extrinsic extensor tendon and the lateral bands from the intrinsic interosseous and lumbrical muscles.
  • DIP flexion is provided by FDP insertion into the volar base. Injury to the FDP at this level results in a Jersey Finger.
  • See Hand Anatomy.

Distal Phalanx Fracture Clinical Evaluation

  • Evaluate finger cascade with flexion. Any overlaps of injured digits indicates need for reduction +/- fixation.
  • Subungual hematoma indicates nail bed injury.

Distal Phalanx Fracture Xray

  • P/A and lateral views of affected finger.

Distal Phalanx Fracture Classification / Treatment

  • Transverse
    -Non-displaced: splint (alumifoam or Stack splints) Active ROM at the DIP joint can be allowed since tendon insertions are intact.
    -Displaced: CRPP
  • Dorsal Base
    -Can be shearing fractures (usually >20% of articular surface) or avulsion fractures (Mallet finger)
    -Non-displaced: splint (alumifoam or Stack splints) with DIP jont immobilized.
    -Displaced: Extension block pinning. (Pegoli L, J Hand Surg 2003;28B:15).
    -See also Mallet finger.
  • Volar Base
    -Can be shearing fractures (usually >20% of articular surface) or FDP avulsion fractures (Type III Jersey Finger).
    -Non-displaced: (rare) splint (alumifoam or Stack splints) with DIP jont immobilized.
    -Displaced: ORIF. Large fragment fixation via suture of mini-fragment screws as indicated. See Jersey Finger for technique.
  • Tuft Fracture
    -Non-displaced: splint (alumifoam or Stack splints)
    -Displaced (dorsal surface of the phalanx displaced): CRPP focused on providing a level dorsal surface to support the nail bed.
    -Commonly associated with nail bed injurieswhich should be treated concomitantly.
  • Longitudinal
    -Non-displaced: splint (alumifoam or Stack splints)
    -Displaced: CRPP with two transverse 0.028-in or 0.035-in K-wires.
  • Pilon
    -Non-displaced: rare, tendon forces usually displace fragments. splint (alumifoam or Stack splints)
    -Displaced: typically severe injuries. Treatment is dependent on the associated soft-tissue injury. Varying combinations of the techniques desribed for volar base and dorsal base fractures should be employed.
    -Often require delayed / secondary DIP joint fusion.

Distal Phalanx Fracture Associated Injuries / Differential Diagnosis

Distal Phalanx Fracture Complications

  • Loss of reduction
  • Delayed union
  • Malunion
  • Nonunion
  • Tendon adhesion / stiffness
  • Nerve or vascular injury
  • Hooked nail / nail deformity

Distal Phalanx Fracture Follow-up

  • Post-op /Initial: Place in alumifoam extension / clamshell / Stack splint. Elevation.
  • 7-10 Days: xray to ensure reduction is maintained. Continued splint, activity modifications. Immobilize as few joints as necessary.
  • 6 Weeks: Remove k-wire, wean from splint use as soon as callus is visible on xray. Continue activity modifications. Agressive DIP ROM.
  • 3 Months: Resume full activities. Assess ROM.
  • 1Yr: assess outcomes / follow-up xrays.

Distal Phalanx Fracture Review References

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate. While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer.