Finger Fractures
What is it: Fracture of the fingers can occur at the distal, middle or proximal phalanx.
How does it present: Patients will often present after an crush or blow to the affected finger. There may be swelling, bruising, pain, and decreased range of motion.
Common exam findings: Exam may confirm swelling, ecchymosis and tenderness and decreased range of motion due to pain. Particularly in distal phalanx fractures, there may be associated subungual hematoma or nail bed injury that may need to be addressed. Evaluate for evidence of malrotation, or that the finger is not aligned as it should be. Always ensure intact neurovascular status. Significant gross deformities on exam are more common with fracture-dislocations of the fingers.
Tests and treatment: X-rays should be sufficient for diagnosis. In general, transverse or longitudinal fractures that are not angulated and non-displaced can be treated with buddy taping for three to four weeks. In the case of a comminuted or "tuft" fracture of the distal phalanx, a protective splint should be applied to prevent further pain from pressure on the digit. If the fractures are angulated, displaced or involve greater than 25% of the articular space, consider referral to orthopedics for management as manipulation or internal fixation may be necessary.