Phalanx Fractures Pathway Posted: 3/5/2022 ID: (C102018)

Ring Finger Proximal Phalanx Fracture in 16M

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PRESENTATION
3
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POLLS
6,522
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OUTCOMES
3
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VIDEOS
4
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EVIDENCE
14
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Comments
33
CASE DESCRIPTION
AGE 16 / Male
CC Left ring finger pain
HPI A 16-year-old male, right-hand dominant, presents to the ED for evaluation of a left-hand injury he sustained while participating in a football game (he plays the center position at a competitive level). He localizes pain to his ring finger. He denies any other injuries.
PMH None
PE Focused physical examination reveals ecchymosis overlying the left ring finger proximal phalanx without any open wounds. Palpation of the ring finger elicits pain. There is no evidence of rotational malalignment but mild shortening of the ring finger within the finger cascade is noted. Motor function is grossly intact as demonstrated by the cardinal hand movements. Sensation is intact to all distributions of the hand. The radial pulse is palpable, and there is brisk cap refill in all the fingers.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/102018/ed9a752f-dcc3-4b47-b184-ec136267fccc_injury_ap.jpg https://upload.orthobullets.com/cases/102018/f822f7c1-909f-432c-9219-9a1b050e4110_injury_oblique.jpg https://upload.orthobullets.com/cases/102018/75f2dd62-04ac-4ca3-8dcd-ffe3d7376c0a_injury_lat.jpg
POLLS
OB Community
1) In addition to the plain film radiographs, would you obtain other imaging to guide management?
Other
2) How would you manage this patient?
Other
3) If you choose Nonoperative management, how would you immobilize the patient?
Other
4) If you choose Operative management, what type of anesthesia would you use?
Other
5) If you choose Operative management, which technique would you utilize?
Other
6) If you choose Open reduction and internal fixation (ORIF), which implant would you choose?
Other
7) If you choose ORIF and obtained the construct below, what type of immobilization would you apply postoperatively?
Other
8) If you choose ORIF and obtained the construct below, when would you begin unrestricted range of motion post-operatively?
Other
9) If you choose ORIF and obtained the construct below, when would you allow the patient to return to competitive football?
Other
CASE OUTCOMES
PROCEDURE 1: Left ring finger proximal phalanx ORIF - CPT 26735
POLL#
SURGEON CHOICE
1
In addition to the plain film radiographs, would you obtain other imaging to guide management?
No - Current radiographs are sufficient
2
How would you manage this patient?
Operative
3
If you choose Nonoperative management, how would you immobilize the patient?
Cast
4
If you choose Operative management, what type of anesthesia would you use?
General anesthesia only
5
If you choose Operative management, which technique would you utilize?
Planned open reduction internal fixation (ORIF)
6
If you choose Open reduction and internal fixation (ORIF), which implant would you choose?
Screw(s) only
7
If you choose ORIF and obtained the construct below, what type of immobilization would you apply postoperatively?
Soft dressings only
8
If you choose ORIF and obtained the construct below, when would you begin unrestricted range of motion post-operatively?
Immediately
9
If you choose ORIF and obtained the construct below, when would you allow the patient to return to competitive football?
5-6 weeks
Post-procedure P1
https://upload.orthobullets.com/cases/102018/bacca7fe-7140-4b00-b8cb-3ab7d8b0a9a2_postop_ap.jpg https://upload.orthobullets.com/cases/102018/5c967051-fa90-41bd-8333-5a6161e69b7b_postop_oblique.jpg https://upload.orthobullets.com/cases/102018/ce0db30b-d85f-4bdd-8a1a-18a2e5a5ecb5_postop_lat.jpg
VIDEOS & PODCASTS (4)
EVIDENCE (14)
EXPERT COMMENTS