Differential Diagnosis

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


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).

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