Thread by @jeremyfaust

Slamming your hand in a car door hurts. 🤬

Especially if you’re a pro athlete or violinist or something...

-We see this and we treat it in the emergency department.
-But there are so key points that you should know...

[a short graphic thread]...

Here’s your X-ray. That’s the distal 5th phalanx. You don’t need to be a board certified radiologist to see this is a displaced fracture. We call this a distal phalanx tuft fracture. Now what? First, check out the finger itself...

As often occurs with these tuft fractures, there’s a fully transected nail laceration. Let’s take a closer look...

Is this considered an open fracture? It’s a little controversial, as I understand it, but YES most people treat it as such. So, antibiotics (cefazolin x 5 days) and that “life-saving tetanus update” as needed. But that’s obviously not enough. We need to make this better! So...

Let’s look at the anatomy. If we don’t repair the laceration, the lunula (that’s the crescent moon-shaped part of the nail at the base) won’t lay down new nail properly.

How do we repair this? You *could* suture it. But that’s not always necessary...

Here’s what I did. I just pushed down on the intact distal nail plate. I heard a nice snap. That was the displaced bone being reduced back into alignment—which is 100% necessary given the X-ray we saw. That reduction also brought the lunula and nail plate perfectly back in line!

Pushing a little harder on the distal nail plate, those borders come together perfectly.
Next, you express a bit more blood, air dry it, and GLUE it in place. This accomplished two things.
-completes the nail laceration repair.
-stabilizes the reduced fracture!
Check it out...

Now we’ve got a reduced open distal phalanx tuft fracture and a repaired nail laceration. Sweet post-reduction film. We applied a pre-fabricated finger splint on after for comfort and immobilization. And we’re done!

Pearl: fractures to the tubular bones of the hand are THE most commonly skeletal injuries in the whole human body. But always get a good history for mechanism. *Some of these (not this one) turn out to be intimate partner violence 🙁 slate.com/technology/201… right @KhuranaBharti?

For more info on management of phalangeal fractures, check this article by Shannon Carpenter and Rachel Rohde out. hand.theclinics.com/article/S0749-…
Thanks for tuning in!