Presentation
Left ring finger injury after jamming finger in a door.
Patient Data
Near completely avulsed nail of the 4th digit, seen as a small “C-shaped” radiodensity medially adjacent to the distal phalanx. Essentially non-displaced, comminuted fracture through the tuft of the distal 4th phalanx.
Case Discussion
Considering the near-complete fingernail avulsion, open wound, and underlying comminuted fracture, empiric antibiotics and referral to orthopedics is recommended. Close clinical follow-up to evaluate for the development of osteomyelitis is advised.
While there are no absolute criteria for referring a distal phalanx fracture, a hand surgery referral is recommended when there is associated nail bed or nail plate injury. All distal phalanx fractures are treated with ice and elevation during the first 24 to 48 hours. Non-displaced distal phalanx fractures should be splinted for at least three to four weeks. A first generation cephalosporin can be considered for grossly contaminated open wounds.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center