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Outlines current management of upper limb conditions in primary care settings

This information is for primary care physicians and a general summary of current practice 

Please consult a physician directly for management of specific injuries  

Distal Phalanx Injuries

Mechanism of Injury:  Crush type of injury and hand trauma

Associated injuries: Distal Phalanx Fractures, FDP Injury , Terminal Extensor Tendon injury, Nail Bed Injury, Skin Defects

Indications for Conservative Management

  • Nail plate intact + no damage to the nail bed

  • Subungual haematoma <50% of nail plate

  • No flexor tendon involvement (DIPJ flex)

  • +/- Terminal extensor tendon injury (DIPJ extension)

  • +/- DP fracture

  • No open wounds/foreign body that increase risk of infection

Distal Phalanx Fracture0002.jpg

Conservative Management in Primary Care

  • Protective splint to the DIP joint if there is a DP fracture and allow movement of the PIP joint  (see photos)

  • If there is no fracture and no tendon involvement, begin movement within pain

  • If terminal extensor tendon is involved, splint DIPJ into neutral extension and refer to a ULQ specialist or hand therapist for review. This injury may or may not require surgical management. Refer to ULQ newsletter on "Zone 1 Extensor Tendon Injuries"

Capp Splint 3.jpg
Capp Splint 2.jpg

Indications for Surgical Management

Refer to ULQ hand surgeon immediately if:

  • Subungual Haematoma >50% of nail plate

  • Nail plate avulsed/dislocated, nail bed loss and/or skin defect (dorsal or volar)

  • Seymours Fracture (see below)

  • +/- Extensor tendon involvement (DIPJ extension)

  • FDP tendon involvement/avulsion  (DIPJ flexion) 

  • Compound Distal Phalanx Fracture

  • Vascular Disruption

  • Foreign body or Infection


Management in Primary Care 

  • ​Use nail plate (if available) to protect the nail bed + use a non-adhesive dressing (i.e mepitel)

  • Immobilise DIPJ in neutral with DP fractures and/or terminal extensor tendon injuries

  • If FDP is damaged, immobilise with a dorsal extension back slab with fingers and wrist included

  • Comminuted DP fractures may need operative stabilisation with k-wire by a fellowship trained hand surgeon

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