Hand

Middle Phalanx Fracture

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Middle Phalanx Fracture

  • See Also
  1. Phalanx Fracture
  2. PIP Extensor Tendon Avulsion (Central Slip Extensor Tendon Injury, Boutonniere Deformity)
  3. PIP Flexor Tendon Avulsion (Volar Plate Injury, Jammed Finger, Swan-Neck deformity)
  4. Dorsal PIP Dislocation
  5. Lateral PIP Dislocation
  6. Volar PIP Dislocation
  • Mechanism
  1. Direct blow or axial load injury
  • Signs
  1. Volar or dorsal angulation
  2. Local swelling, Bruising and tenderness overlying Fracture
  3. Evaluate for malrotation (overlap deformity of affected finger when flexing fingers into a fist)
    1. Axes of all flexed fingers should point toward Scaphoid Bone or radial styloid (thenar eminence)
    2. OrthoHandPositionFistToScaphoid.jpg
  • Imaging
  • XRay of Digit (AP, Lateral, Oblique)
  1. Evaluate for intraarticular, oblique, spliral or rotational Fractures (require orthopedic referral)
  2. Perform before and after manual reduction
  • Management
  • Minimally Angulated, Extraarticular Fractures NOT Requiring Reduction
  1. Indications
    1. Minimal angulation (<10 degrees) AND
    2. Minimal to no displacement AND
    3. Extraarticular Fracture
  2. Management
    1. Buddy taping (between IP joints) to the adjacent finger for 3 to 4 weeks
    2. Aluminum splint and refer if any concerns for more complicated Fractures (see below)
    3. Repeat evaluation at 7 to 10 days to confirm alignment, then again at 3-4 weeks
  • Management
  • Fractures Requiring Reduction
  1. Reduction
    1. Anesthesia: Digital Block or Hematoma Block
    2. Reduce by traction and manipulation of finger
  2. Immobilization after successful reduction
    1. Dorsal aluminum splint in extension for 6 weeks, then buddy taping for an additional 6 weeks OR
    2. Consider initial radial gutter or Ulnar Gutter Splint in complicated or unstable Fractures
  3. Post-Reduction Assessment
    1. Evaluate for even subtle rotation
    2. Methods
      1. Repeat finger XRay after reduction
      2. Flexed fingers should all point toward Scaphoid or radial styloid (thenar eminence)
        1. OrthoHandPositionFistToScaphoid.jpg
  4. Follow-up
    1. Repeat XRay at 7 to 10 days to confirm alignment
    2. Follow-up every 2 weeks
    3. Anticipate at least 4 to 6 weeks for healing
  5. Orthopedic referral indications
    1. Joint surface involved >30%
    2. Inadequate Fracture reduction (e.g. persistent malrotation)
    3. Intraarticular Fracture
  • References
  1. Childress (2022) Am Fam Physician 105(6): 631-9 [PubMed]