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Phalanx Fractures
Posted: Mar 5 2022 #(C102018)
A

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.

Poll
1 of 9
1. In addition to the plain film radiographs, would you obtain other imaging to guide management?
No - Current radiographs are sufficient
93%
820/874
Yes - additional radiographs (aXR)
2%
19/874
Yes - CT scan (CT)
1%
16/874
Yes - MRI
0%
6/874
Yes - aXR + CT
0%
1/874
Yes - aXR + MRI
0%
0/874
Yes - CT + MRI
0%
0/874
Yes - aXR + CT + MRI
0%
1/874
Outside my area of expertise - best if I don't vote
1%
11/874
2. How would you manage this patient?
Nonoperative
48%
422/870
Operative
49%
431/870
Outside my area of expertise - best if I don't vote
1%
17/870
3. If you choose Nonoperative management, how would you immobilize the patient?
I would not choose Nonoperative management
27%
237/857
Soft dressings only (no immobilization)
7%
64/857
Removable splint/brace
33%
285/857
Cast
26%
228/857
Other
3%
28/857
Outside my area of expertise - best if I don't vote
1%
15/857
4. If you choose Operative management, what type of anesthesia would you use?
I would not choose Operative management
20%
174/834
Wide awake (tumescent local anesthesia)
11%
97/834
Peripheral nerve block with sedation
36%
302/834
Peripheral nerve block without sedation
18%
154/834
General anesthesia only
10%
86/834
Outside my area of expertise - best if I don't vote
2%
21/834
5. If you choose Operative management, which technique would you utilize?
I would not choose Operative management
15%
130/823
External fixation (ExFix) only
1%
9/823
Closed reduction percutaneous fixation (CRPP), only convert to open if needed
42%
349/823
Planned open reduction internal fixation (ORIF)
38%
314/823
Outside my area of expertise - best if I don't vote
2%
21/823
6. If you choose Open reduction and internal fixation (ORIF), which implant would you choose?
I would not choose ORIF
17%
140/807
K-wire(s) only
14%
119/807
Screw(s) only
51%
413/807
Intramedullary nail
1%
13/807
Plate and screw(s)
12%
99/807
Outside my area of expertise - best if I don't vote
2%
23/807
7. If you choose ORIF and obtained the construct below, what type of immobilization would you apply postoperatively?
I would not choose ORIF
12%
95/733
Soft dressings only
34%
253/733
Brace/Splint
44%
327/733
Cast
5%
43/733
Outside my area of expertise - best if I don't vote
2%
15/733
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%
69/728
Immediately
28%
206/728
1-2 weeks
27%
200/728
3-4 weeks
24%
177/728
5-6 weeks
6%
46/728
> 6 weeks
2%
16/728
Outside my area of expertise - best if I don't vote
1%
14/728
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%
62/738
3-4 weeks
5%
39/738
5-6 weeks
23%
171/738
7-8 weeks
25%
190/738
9-10 weeks
6%
51/738
11-12 weeks
13%
98/738
> 12 weeks
14%
109/738
Outside my area of expertise - best if I don't vote
2%
18/738
PROCEDURE #1

Left ring finger proximal phalanx ORIF - CPT 26735

POLL#
Surgeon's Choices
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
icon
OUTCOMES
Post-procedure P1
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