What is included in the treatment of distal phalanx fractures?

Updated: Jan 18, 2018
  • Author: Jay E Bowen, DO; Chief Editor: Craig C Young, MD  more...
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Tuft fractures are treated by caring for the accompanying soft-tissue injury and splinting of the finger to prevent further discomfort or injury. A variety of splinting devices can be used for loose protection. In the closed crush fracture of the distal phalanx, the L -shaped Alumafoam splint placed on the volar aspect to protect the soft tissues is considered the best treatment. Tight circumferential taping around the fingertip should not be used because of an increased risk of circulatory compromise. Splinting is generally maintained for about 2-3 weeks.

Avulsion of the nail plate and injury to the nail bed is often associated with tuft fractures. It is necessary to reduce the nail plate under the eponychium, and if this cannot be performed, the plate can be removed. The distal phalanx may be destabilized to some extent, but as there are no tendons attached to the tuft of the distal phalanx, these injuries rarely displace. If the nail is removed during repair, packing of the eponychial space with petroleum gauze is used to prevent scarring and closure of the space, which could lead to stunted nail growth. Tuft fractures may progress to nonunion but are usually asymptomatic.

Open fractures of the distal phalanx require thorough cleansing, debridement, and inspection for foreign bodies. Orthopedic assistance is not required for uncomplicated closures. Open fractures with extensive soft-tissue damage are frequently associated with chronic pain and disability and may need orthopedic assistance. Open fractures of the distal phalanx require a course of antibiotic treatment.

The shaft of the distal phalanx is very narrow and mostly cortical. Fractures at this location can be problematic. Nonunion can be symptomatic; occasionally, these require internal fixation.

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