What's the diagnosis? By Dr. Erica Schramm
A 55 yo female with a high BMI presents with left fifth toe pain and obvious deformity after trip and fall. She has no wounds. An x-ray of the affected toe is shown. What's the diagnosis? Scroll down for answer.
Answer: Closed displaced fracture of the left fifth proximal phalanx
- proximal phalanx fracture of the of the 5th toe is the second most common toe fracture
- nondisplaced fractures of the 2nd-5th phalanges can be treated with buddy taping and hard soled shoe
- nondisplaced fractures do not require orthopedic (or podiatry) follow up
- displaced fractures should ve reduced in the ED using a digital block and manual reduction or finger trap, followed by buddy taping and hard soled shoe
- displaced fractures require orthopedic (or podiatry) follow up
- many fractures area associated with subungal hematoma; hematomas covering >50% of the nail bed should be treated with trephination
- nondisplaced great toe fractures require a posterior splint; displaced and comminuted great toe fractures reduction and posterior splint, eventual walking cast
- all great toe fractures require orthopedic (or podiatry) follow up
Hanlon, Dennis, and Christopher Morris. "Foot." Simon's Emergency Orthopedics, 8e Ed. Scott C. Sherman. New York, NY: McGraw-Hill, 2019.
Leuck, JoAnna, and Tyler Hedman. "Toe Fracture Management." Reichman's Emergency Medicine Procedures, 3e Ed. Eric F. Reichman. New York, NY: McGraw-Hill, 2019.
Davenport, Moira."Arm and Hand Lacerations." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016