Distal Phalanx Fractures
Beware nail bed injury!
XRAY ALL NAILBED INJURIES ? fracture
Refer fracture with nail avulsion or obvious laceration to Plastics.
Subungal haematoma should raise suspicion of open fracture and thus nailpate should be removed to allow irrigation and repair
Refer to Plastics.
MECHANISM
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Crush injury - TUFT FRACTURE
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age 0-6 years
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With or without Nail bed injury
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Hyperflexion forces causing epyphyseal injury.
CLASSIFICATION
Phalanx growth plates are at basal end (metacarpal at distal)
Classification
A displaced distal physeal fracture with assocaited nail bed injury.
MANAGEMENT
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Analgesia
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SH I and II injury Buddy strap and Fracture clinic locally.
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SH III and IV can be reduced by extending terminal fragment and massaging fragment into place, splint on flexor surface. Follow up Plastics Hand Trauma Clinic.
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Associated nail bed injury or subungal haematoma - refer Plastics.