A 32-Year-Old Male with Pain After Dropping a 20-Pound Weight on his Finger

Differential Diagnosis

• Dislocation
• Distal phalanx fracture
• Mallet finger
• Osteomyelitis
• Osteosarcoma

Diagnosis

The x-ray reveals a nondisplaced distal phalangeal fracture. Note the subtle vertical lucency within the distal phalanx.

Learnings/What to Look for

• It is essential to evaluate for fracture fragments, lucency, disruption of the trabeculations, or a break in the cortex
• Localized images (eg, a dedicated finger x-ray vs a hand x-ray) may allow for better resolution and magnification
• Establish neurovascular status on initial assessment

Pearls for Urgent Care Management

• Splinting in the urgent care center with return for follow-up, or referral to orthopedics for follow-up, is appropriate
• Document the presence or absence of associated laceration to clarify if there is an open fracture
  • Open fracture is associated with chronic pain and may require antibiotic treatment
• Consider trephination for drainage in the presence of an associated subungual hematoma

Acknowledgment: Image and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).