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Ring Finger Proximal Phalanx Fracture in 16M
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.
1.
In addition to the plain film radiographs, would you obtain other imaging to guide management?
No - Current radiographs are sufficient
93%
795/846
Yes - additional radiographs (aXR)
2%
17/846
Yes - CT scan (CT)
1%
15/846
Yes - MRI
0%
6/846
Yes - aXR + CT
0%
1/846
Yes - aXR + MRI
0%
0/846
Yes - CT + MRI
0%
0/846
Yes - aXR + CT + MRI
0%
1/846
Outside my area of expertise - best if I don't vote
1%
11/846
2.
How would you manage this patient?
Nonoperative
48%
408/840
Operative
49%
415/840
Outside my area of expertise - best if I don't vote
2%
17/840
3.
If you choose Nonoperative management, how would you immobilize the patient?
I would not choose Nonoperative management
27%
228/831
Soft dressings only (no immobilization)
7%
64/831
Removable splint/brace
33%
280/831
Cast
26%
220/831
Other
3%
26/831
Outside my area of expertise - best if I don't vote
1%
13/831
4.
If you choose Operative management, what type of anesthesia would you use?
I would not choose Operative management
21%
170/808
Wide awake (tumescent local anesthesia)
11%
95/808
Peripheral nerve block with sedation
35%
290/808
Peripheral nerve block without sedation
18%
149/808
General anesthesia only
10%
85/808
Outside my area of expertise - best if I don't vote
2%
19/808
5.
If you choose Operative management, which technique would you utilize?
I would not choose Operative management
16%
129/799
External fixation (ExFix) only
1%
9/799
Closed reduction percutaneous fixation (CRPP), only convert to open if needed
42%
341/799
Planned open reduction internal fixation (ORIF)
37%
301/799
Outside my area of expertise - best if I don't vote
2%
19/799
6.
If you choose Open reduction and internal fixation (ORIF), which implant would you choose?
I would not choose ORIF
17%
139/784
K-wire(s) only
14%
116/784
Screw(s) only
51%
402/784
Intramedullary nail
1%
12/784
Plate and screw(s)
12%
95/784
Outside my area of expertise - best if I don't vote
2%
20/784
7.
If you choose ORIF and obtained the construct below, what type of immobilization would you apply postoperatively?
I would not choose ORIF
13%
94/711
Soft dressings only
34%
247/711
Brace/Splint
44%
316/711
Cast
5%
41/711
Outside my area of expertise - best if I don't vote
1%
13/711
8.
If you choose ORIF and obtained the construct below, when would you begin unrestricted range of motion post-operatively?
I would not choose ORIF
9%
68/706
Immediately
28%
200/706
1-2 weeks
27%
196/706
3-4 weeks
24%
171/706
5-6 weeks
6%
45/706
> 6 weeks
1%
14/706
Outside my area of expertise - best if I don't vote
1%
12/706
9.
If you choose ORIF and obtained the construct below, when would you allow the patient to return to competitive football?
I would not choose ORIF
8%
62/716
3-4 weeks
5%
39/716
5-6 weeks
23%
168/716
7-8 weeks
25%
184/716
9-10 weeks
6%
50/716
11-12 weeks
13%
96/716
> 12 weeks
14%
101/716
Outside my area of expertise - best if I don't vote
2%
16/716
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
OUTCOMES
Post-procedure P1