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Distal Phalanx Fracture S62.523A 816.02

Distal interphalangeal joint anatomy

Finger extension apparatus

synonyms:

Distal Phalanx Fracture ICD-10

Distal Phalanx Fracture ICD-9

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

Distal Phalanx Fracture CPT Codes

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.

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