Great toe fractures are treated with a short leg walking boot or cast with toe plate for two to three weeks, then a rigid-sole shoe for an additional three to four weeks. A 26-year-old professional ballet dancer presents with insidious onset of right midfoot pain which began 6 months ago. Your video is converting and might take a while Feel free to come back later to check on it. angel academy current affairs pdf . Hallux fractures. Spiral fractures often lead to rotation or shortening, and transverse fractures lead to angulation.6. The next bone is called the proximal phalanx. Search dates: February and June 2015. She is active in ballet and her pain is exacerbated with push-off and en pointe maneuvers. Displaced fractures of the lesser toes should be treated with reduction and buddy taping. We help you diagnose your Toe fractures case and provide detailed descriptions of how to manage this and hundreds of other pathologies . Patients usually present with a painful, swollen, ecchymotic toe with variable deformity and gait disturbance. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Narcotic analgesics may be necessary in patients with first-toe fractures, multiple fractures, or fractures requiring reduction. 2 ). Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. These bones comprise 2 bones in the hindfoot (calcaneus, talus), [ 1, 2] 5 bones in the midfoot (navicular, cuboid, 3. Fractures of the toes and forefoot are quite common. Deformity, decreased range of motion, and degenerative joint disease in this toe can impair a patient's functional ability. If you have an open fracture, however, your doctor will perform surgery more urgently. Joint hyperextension and stress fractures are less common. Fractures of the lesser toes are four times as common as fractures of the first toe.3 Most toe fractures are nondisplaced or minimally displaced. Repeat radiography is indicated and should be obtained one week post-fracture if there was intra-articular involvement or if a reduction was required. 11(2): p. 121-3. and S. Hacking, Evaluation and management of toe fractures. abductor, interosseous and adductor linked with proximal phalanx may aggravate fracture of the toe bones if these muscles get sudden pull. The reduced fracture is splinted with buddy taping. X-rays. More sensitive than an X-ray, an MRI can detect changes in the bone that may indicate a fracture. Phalangeal fractures are very common, representing approximately 10% of all fractures that present to the emergency room. This is called a "stress fracture.". The flexor and extensor tendons impart a longitudinal compression force, which can shorten the phalanx and extend the distal fragment [ 1 ]. Stress fractures are small cracks in the surface of the bone that may extend and become larger over time. Foot Ankle Int, 2015. All Rights Reserved. Phalanx fractures are classified by the following: Phalangeal fractures are the most common foot fracture in children. Minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts (Figure 2) and fractures with less than 10 of dorsoplantar angulation in the absence of other injuries can generally be managed in the same manner as nondisplaced fractures.24,6 Initial management includes immobilization in a posterior splint (Figure 311 ), use of crutches, and avoidance of weight-bearing activities. Epub 2012 Mar 30. Posterior splint; nonweight bearing; follow-up in three to five days, Short leg walking cast with toe plate or boot for six weeks; follow-up every two to four weeks; healing time of six weeks, Repeat radiography at one week and again at four to six weeks, Open fractures; fracture-dislocations; intra-articular fractures; fractures with displacement or angulation, Short leg walking boot or cast for six weeks; follow-up every two to four weeks; healing time of six weeks, Repeat radiography at one week and again at four to eight weeks, Open fractures; fracture-dislocations; multiple metatarsal fractures; displacement > 3 to 4 mm in the dorsoplantar plane; angulation > 10 in the dorsoplantar plane, Three-view foot series with attention to the oblique view, Compressive dressing; ambulate as tolerated; follow-up in four to seven days, Short leg walking boot for two weeks, with progressive mobility and range of motion as tolerated; follow-up every two to four weeks; healing time of four to eight weeks, Repeat radiography at six to eight weeks to document healing, Displacement > 3 mm; step-off > 1 to 2 mm on the cuboid articular surface; fracture fragment that includes > 60% of the metatarsal-cuboid joint surface, Short leg nonweight-bearing cast for six to eight weeks; cast removal and gradual weight bearing and activity if radiography shows healing at six to eight weeks, or continue immobilization for four more weeks if no evidence of healing; healing time of six to 12 weeks, Repeat radiography at one week for stability and at the six- to eight-week follow-up; if no healing at six to eight weeks, repeat radiography at the 10- to 12-week follow-up, Displacement > 2 mm; 12 weeks of conservative therapy ineffective with nonunion revealed on radiography; athletes or persons with high activity level, Three-view foot series or dedicated phalanx series, Short leg walking boot; ambulate as tolerated; follow-up in seven days, Short leg walking boot or cast with toe plate for two to three weeks, then may progress to rigid-sole shoe for additional three to four weeks; follow-up every two to four weeks; healing time of four to six weeks, Repeat radiography at one week if fracture is intra-articular or required reduction, Fracture-dislocations; displaced intra-articular fractures; nondisplaced intra-articular fractures involving > 25% of the joint; physis (growth plate) fractures, Buddy taping and rigid-sole shoe; ambulate as tolerated; follow-up in one to two weeks, Buddy taping and rigid-sole shoe for four to six weeks; follow-up every two to four weeks; healing time of four to six weeks, Displaced intra-articular fractures; angulation > 20 in dorsoplantar plane; angulation > 10 in the mediolateral plane; rotational deformity > 20; nondisplaced intra-articular fractures involving > 25% of the joint; physis fractures. If more than 25% of the joint surface is involved or if the displacement is more than 2 to 3 mm, closed or open reduction is indicated. Interosseus muscles and lumbricals insert onto the base of the proximal phalanx and flex the proximal fragment. Smith, Epidemiology of lawn-mower-related injuries to children in the United States, 1990-2004. A radiograph, bone scan, and MRI are found in Figures A-C, respectively. If the bone is out of place and your toe appears deformed, it may be necessary for your doctor to manipulate, or reduce, the fracture. Proximal interphalangeal joint (PIPJ) dislocation is one of the most common hand injuries. Copyright 2023 American Academy of Family Physicians. Foot fractures range widely in severity, prognosis, and treatment. Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, He Is Playing With Nonoperative Treatment - Michael Coughlin, MD, He Is Out! They typically involve the medial base of the proximal phalanx and usually occur in athletes. If no healing has occurred at six to eight weeks, avoidance of weight-bearing activity should continue for another four weeks.2,6,20 Typical length of immobilization is six to 10 weeks, and healing time is typically up to 12 weeks. Ribbans, W.J., R. Natarajan, and S. Alavala, Pediatric foot fractures. A walking cast with a toe platform may be necessary in active children and in patients with potentially unstable fractures of the first toe. Lgters TT, A combination of anteroposterior and lateral views may be best to rule out displacement. Tuberosity avulsion fractures are generally found in zone 1 and do not extend into the joint between the fourth and fifth metatarsal bases (Figures 7 and 9). Although often dismissed as inconsequential, toe fractures that are improperly managed can lead to significant pain and disability. And finally, the webinar will cover fixation techniques, including various instrumentation options.Moderator:Jeffrey Lawton, MDChief, Hand and Upper ExtremityProfessor, Orthopaedic SurgeryAssociate Chair for Quality and Safety, Orthopaedic SurgeryProfessor, Plastic SurgeryUniversity of MichiganAnn Arbor, MichiganFaculty: Charles Cassidy, MDHenry H. Banks Professor and ChairmanDepartment of OrthopaedicsTufts Medical CenterBoston, MassachusettsChaitanya Mudgal, MD, MS (Ortho), MChHand Surgery ServiceDepartment of OrthopedicsMassachusetts General HospitalChairman, AO NA Hand Education CommitteeAssociate Professor, Orthopedic Surgery, Harvard Medical SchoolBoston, MassachusettsAmit Gupta, MD, FRCSProfessorDepartment of Orthopaedic SurgeryUniversity of LouisvilleLouisville, KentuckyRebecca Neiduski, PhD, OTR/L, CHTDean of the School of Health SciencesProfessor of Health SciencesElon UniversityElon, North Carolina, Ring Finger Proximal Phalanx Fracture in 16M. Patients with Jones fractures should be referred if there is more than 2 mm of displacement, if conservative therapy is ineffective after 12 weeks of immobilization and radiography reveals nonunion, or if the patient is an athlete or is highly active.2,13,2022, Toe fractures are the most common fractures of the foot.23,24 Most fractures involve minimal displacement and are treated nonsurgically. Healing of a broken toe may take 6 to 8 weeks. The skin should be inspected for open fracture and if . Fractures of multiple phalanges are common (Figure 3). The appropriate treatment depends on the location of the fracture, the amount of displacement (shifting of the two ends of the fracture), and activity level of the patient. To enhance comfort, some patients prefer to cut out the part of the shoe that overlies the fractured toe. (OBQ05.226) These tendons may avulse small fragments of bone from the phalanges; they also can be injured when a toe is fractured. What is the most likely diagnosis? The nail should be inspected for subungual hematomas and other nail injuries. Patients with lesser toe fractures with angulation of more than 20 in the dorsoplantar plane, more than 10 in the mediolateral plane, or more than 20 rotational deformity should also be referred.6,23,24. Patients should limit icing to 20 minutes per hour so that soft tissues will not be injured. All rights reserved. Physical examination reveals marked tenderness to palpation. Patients typically present with pain, swelling, ecchymosis, and difficulty with ambulation. 68(12): p. 2413-8. The same mechanisms that produce toe fractures may cause a ligament sprain, contusion, dislocation, tendon injury, or other soft tissue injury. Which of the following is responsible for the apex palmar fracture deformity noted on the preoperative radiographs? Evidence has shown that, depending on symptoms, short leg walking boots are superior to short leg walking casts.18,19 Immobilization in a cast or boot is typically only needed for two weeks, with progressive ambulation and range of motion thereafter as tolerated. Physical examination findings typically include tenderness to palpation, swelling, ecchymosis, and sometimes crepitation at the fracture site. Referral is indicated in patients with circulatory compromise, open fractures, significant soft tissue injury, fracture-dislocations, displaced intra-articular fractures, or fractures of the first toe that are unstable or involve more than 25 percent of the joint surface. At the conclusion of treatment, radiographs should be repeated to document healing. During this time, it may be helpful to wear a wider than normal shoe. In most cases, a fracture will heal with rest and a change in activities. Patients with closed, stable, nondisplaced fractures can be treated with splinting and a rigid-sole shoe to prevent joint movement. Bicondylar proximal phalanx fractures usually are treated with plate fixation. Minimally displaced (less than 3 mm) avulsion fractures typically require immobilization and support with a short leg walking boot. Your doctor will tell you when it is safe to resume activities and return to sports. Epidemiology Incidence 21(1): p. 31-4. In children, a physis (i.e., cartilaginous growth center) is present in the proximal part of each phalanx (Figure 2). Patients with these fractures should be referred to an orthopedist.2,3,6, The fifth metatarsal has the least cortical thickness of all the metatarsals.13 There are multiple strong ligamentous and capsular attachments surrounding the proximal fifth metatarsal; these allow stresses to be directed through this portion of the bone.13 Classically, fractures of the proximal fifth metatarsal can be classified based on anatomic location into one or more of three zones (Figure 7).3. To unlock fragments, it may be necessary to exaggerate the deformity slightly as traction is applied or to manipulate the fragments with one hand while the other maintains traction. Physicians should consider referring patients with fractures of the great toe that have any degree of displacement, angulation, or rotational deformity 6,24 (Figure 12). There are 3 phalanges in each toe except for the first toe, which usually has only 2. An avulsion fracture is also sometimes called a "ballerina fracture" or "dancer's fracture" because of the pointe position that ballet dancers assume when they are up on their toes. She has no history of ankle or foot trauma, and medical history is significant only for delayed menarche. Phalangeal fractures are the most common foot fracture in children. Proximal metaphyseal. The Ottawa Ankle and Foot Rules should be applied when examining patients with suspected fractures of the proximal fifth metatarsal to help decide whether radiography is needed14 (Figure 815 ). Stress fractures can occur in toes. They most often involve the metatarsals and toes. laceration bone talks, extensor tendon injuries hand orthobullets, flexor and extensor tendon injuries phoenix az arizona, tendon lacerations twin boro physical therapy, repair and rehabilitation of extensor hallucis longus and, extensor mechanism injury hip amp knee book, Healing time is typically four to six weeks. MB BULLETS Step 1 For 1st and 2nd Year Med Students. The "V" sign (arrow) indicates dorsal instability. One of the most common foot fractures in children, Open fractures require irrigation & debridement, Nail-bed injuries involving the germinal matrix should be repaired, Displaced intra-articular fractures of the hallux require reduction. Even with proper healing, your foot may be swollen for several months, and it may be hard to find a comfortable shoe. If stable, the patient can be transitioned to a short leg walking cast or boot3,6 (Figures 411 and 5). Although tendon injuries may accompany a toe fracture, they are uncommon. Foot radiography is required if there is pain in the midfoot zone and any of the following: bone tenderness at point C (base of the fifth metatarsal) or D (navicular), or inability to bear weight immediately after the injury and at the time of examination.14 When used properly, the Ottawa Ankle and Foot Rules have a sensitivity of 99% and specificity of 58%, with a positive likelihood ratio of 2.4 and a negative likelihood ratio of 0.02 for detecting fractures. Clin J Sport Med, 2001. Open reduction and placement of two 0.045-inch K-wires placed longitudinally through the metacarpal head, Application of a 1.5-mm straight plate applied dorsally through and extensor tendon splitting approach, Open reduction and lag screw fixation with 1.3mm screws through a radial approach, Placement of a 1.5-mm condylar blade plate through a radial approach, Open reduction and retrograde passage of two 0.045-inch K-wires retrograde trough the PIP joint. A fractured toe may become swollen, tender, and discolored. Kensinger, D.R., et al., The stubbed great toe: importance of early recognition and treatment of open fractures of the distal phalanx. Because it is the longest of the toe bones, it is the most likely to fracture. Metatarsal shaft fractures most commonly occur as a result of twisting injuries of the foot with a static forefoot, or by excessive axial loading, falls from height, or direct trauma.2,3,6 Patients may have varying histories, ranging from an ill-defined fall to a remote injury with continued pain and trouble ambulating. Proximal phalanx (finger) fracture Contents 1 Background The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity [1] Extensor tendons and interosseous muscles commonly causes volar angulation [1] Clinical Features Finger pain Differential Diagnosis Hand and Finger Fractures An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which makes fractures about the physis likely. Radiographic evaluation is dependent on the toe affected; a complete foot series is not always necessary unless the patient has diffuse pain and tenderness. Rotator Cuff and Shoulder Conditioning Program. Three muscles, viz. After that, nonsurgical treatment options include six to eight weeks of short leg nonweight-bearing cast with radiographic follow-up to document healing at six to eight weeks.2,6,20 If evidence of healing is present (callus formation and lack of point tenderness) at that time, weight-bearing activity can progress gradually, along with physical therapy and rehabilitation. Initial follow-up should occur within one to two weeks, then every two to four weeks for a total healing time of four to six weeks.6,23,24 Radiographic follow-up in seven to 10 days is necessary for fractures that required reduction or that involve more than 25% of the joint.6, Indications for referral of toe fractures include a fracture-dislocation, displaced intra-articular fractures, nondisplaced intra-articular fractures involving more than 25% of the joint, and physis (growth plate) fractures. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. The collateral ligaments and volar plate at the metacarpophalangeal (MCP) joint stabilize the proximal portion and the extensor tendon pulls the distal fragment into extension. Early surgical management of a Jones fracture allows for an earlier return to activity than nonsurgical management and should be strongly considered for athletes or other highly active persons. 3 Patients with phalanx fractures typically present with pain at or near the site of injury, edema, ecchymosis, and erythema. Follow-up/referral. Patients have localized pain, swelling, and inability to bear weight on the lateral aspect of the foot. Am Fam Physician, 2003. There should be at least three images of the affected toe, including anteroposterior, lateral, and oblique views, with visualization of the adjacent toes and of the joints above and below the suspected fracture location. Follow-up should occur within three to five days to allow for reduction of soft tissue swelling. Initial management of a Jones fracture includes a posterior splint and avoidance of weight-bearing activity, with follow-up in three to five days. You can rate this topic again in 12 months. Because of the first toe's role in weight bearing, balance, and pedal motion, fractures of this toe require referral much more often than other toe fractures. If your doctor suspects a stress fracture but cannot see it on an X-ray, they may recommend an MRI scan. Referral is recommended for children with fractures involving the physis, except nondisplaced Salter-Harris type I and type II fractures (Figure 6).4. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. A Jones fracture is a horizontal or transverse fracture at the base of the fifth metatarsal. Published studies suggest that family physicians can manage most toe fractures with good results.1,2. toe phalanx fracture orthobullets Application of a gentle axial loading force distal to the injury (i.e., compressing the distal phalanx toward the foot) may distinguish contusions from fractures. Open fractures, Infection, Compartment syndrome 3; References, Classification, Courses 3; Distal articular. Although adverse outcomes can occur with toe fractures,3 disability from displaced phalanx fractures is rare.5. When performed on 18 children with distal radius-ulna fractures, P_STAR achieved near anatomic fracture alignment with no nerve or tendon injury, infection, or refracture. imbalance after flexor tendon repair seems to be thus, extensor tendon injuries occur frequently an in depth understanding of the intricate anatomy of the extensor mechanism is necessary to guide management careful counseling is helpful in Nondisplaced or minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts with less than 10 of angulation can be treated conservatively with a short leg walking boot, cast shoe, or elastic bandage, with progressive weight bearing as tolerated. Stable, nondisplaced toe fractures should be treated with buddy taping and a rigid-sole shoe to limit joint movement. Proximal phalanx fractures often present with apex volar angulation. This website also contains material copyrighted by third parties. In most cases, this is done by simply adjusting the direction of traction to correct any shortening, rotation, or malalignment. The choice of immobilization device depends on the patient's ability to ambulate with the device with minimal to no pain. (SBQ17SE.3) After the splint is discontinued, the patient should begin gentle range-of-motion (ROM) exercises with the goal of achieving the same ROM as the same toe on the opposite foot. Proximal articular. Pediatr Emerg Care, 2008. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. A 20-year-old male military recruit slams his index finger on a tank hatch and sustains the injury seen in Figure A. Immobilization of the distal interphalangeal joint is required for 2 weeks post-operatively, High rates of post-operative infection are common, Open reduction via an approach through the nail bed leads to significant post-operative nail deformity, Range of motion of the DIP joint in the affected finger is usually less than 10 degrees post-operatively, Type in at least one full word to see suggestions list, Management of Proximal Phalanx Fractures & Their Complications, Middle Finger, Proximal Phalangeal Head - Bicondylar Fracture - Fixation, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, PIP Fracture & Dislocation: Case of the Week - Shaan Patel, MD, Ring Finger Proximal Phalanx Fracture in 16M, Fracture of the base of proximal phalanx of 5th finger. A radiograph taken at the time of injury is shown in Figure A, and a current radiograph is shown in Figure B. Toe and forefoot fractures often result from trauma or direct injury to the bone. Referral should be strongly considered for patients with nondisplaced intra-articular fractures involving more than 25 percent of the joint surface (Figure 4).4 These fractures may lose their position during follow-up. The thumb connects to the hand through the next joint, known as the metacarpophalangeal (MCP) joint. Concerns with delayed healing and/or high activity demands may result in your doctor recommending surgery for an acute Jones fracture as well. J AmAcad Orthop Surg, 2001. Phalanx fractures: The most common foot fractures Phalanx fractures typically occur by crush injury, hyperextension, or direct axial force (eg, stubbing the toe). A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. The use of musculoskeletal ultrasonography may be considered to diagnose subtle metatarsal fractures. rest, NSAIDs, taping, stiff-sole shoe, or walking boot in the majority of cases. In this type of injury, the tendon that attaches to the base of the fifth metatarsal may stretch and pull a fragment of bone away from the base. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. All the bones in the forefoot are designed to work together when you walk. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. The forefoot has 5 metatarsal bones and 14 phalanges (toe bones). Taping may be necessary for up to six weeks if healing is slow or pain persists. Copyright 2023 Lineage Medical, Inc. All rights reserved. Nondisplaced fractures usually are less apparent; however, most patients with toe fractures have point tenderness over the fracture site. If the wound communicates with the fracture site, the patient should be referred. They can also result from the overuse and repetitive stress that comes with participating in high-impact sports like running, football, and basketball. Management is determined by the location of the fracture and its effect on balance and weight bearing. Surgeons will learn to assess and evaluate phalangeal anatomy and fracture geometry. The proximal phalanx is the toe bone that is closest to the metatarsals. Common presenting symptoms include bruising, swelling, and throbbing pain that worsens with a dependent position, although this type of pain also may occur with an isolated subungual hematoma. Fracture of the proximal phalanx of the little finger in children: a classification and a method to measure the deformity . The localized tenderness of a contusion may mimic the point tenderness of a fracture. For several days, it may be painful to bear weight on your injured toe. (OBQ05.209) Which of the following is true regarding open reduction and screw fixation of this injury? Therefore, phalanges and digits adjacent to the fracture must be examined carefully; joint surfaces also must be examined for intra-articular fractures (Figure 3). Most children with fractures of the physis should be referred, but children with selected nondisplaced Salter-Harris types I and II fractures may be treated by family physicians. (Left) In this X-ray, a fracture in the proximal phalanx of the fifth toe (arrow) has caused the toe to become deformed. Fractures in this area can occur anytime there is a break in the compact bone matrix that makes up the proximal phalanx. Displaced spiral fractures generally display shortening or rotation, whereas displaced transverse fractures may display angulation. hand fractures orthoinfo aaos metatarsal fractures foot ankle orthobullets phalanx fractures hand orthobullets fractures of the fifth metatarsal physio co uk 5th metatarsal . A 39-year-old male sustained an index finger injury 6 months ago and has failed eight weeks of splinting. In children, a physis (i.e., cartilaginous growth center) is present in the proximal part of each phalanx ( Figure 2). Fractures can result from a direct blow to the foot such as accidentally kicking something hard or dropping a heavy object on your toes. Non-narcotic analgesics usually provide adequate pain relief. Common mechanisms of injury include: Axial loading (stubbing toe) Abduction injury, often involving the 5th digit Crush injury caused by a heavy object falling on the foot or motor vehicle tyre running over foot Less common mechanism: If a fracture is present, it will typically be one of two types: a tuberosity avulsion fracture or a Jones fracture (i.e., proximal fifth metatarsal metadiaphyseal fracture). Most broken toes can be treated without surgery. Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Type in at least one full word to see suggestions list, 2022 California Orthopaedic Association Annual Meeting, COA Foot and Ankle End - Glenn Pfeffer, MD, Comminuted Fifth Metatarsal Fracture in 28M. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. If this maneuver produces sharp pain in a more proximal phalanx, it suggests a fracture in that phalanx. To control pain and swelling, patients should apply ice and elevate the affected foot for the first few days after the injury. (SBQ17SE.89) It ossifies from one center that appears during the sixth month of intrauterine life. This usually occurs from an injury where the foot and ankle are twisted downward and inward. A Jones fracture has a higher risk of nonunion and requires at least six to eight weeks in a short leg nonweight-bearing cast; healing time can be as long as 10 to 12 weeks. The image shows a diagram of where these bones lie in the footthe midpoint of the proximal phalanges being where to the toes branch off from the main body of the foot. Nondisplaced acute metatarsal shaft fractures generally heal well without complications. Remodeling of the fracture callus generally produces an almost normal appearance of the bone over a matter of months (Figure 26-36). Abductor, interosseus, and adductor muscles insert at the proximal aspects of each proximal phalanx. All material on this website is protected by copyright. While celebrating the historic victory, he noticed his finger was deformed and painful. The fractures reviewed in this article are summarized in Table 1. Note that the volar plate (VP) attachment is involved in the . A fracture that is not treated can lead to chronic foot pain and arthritis and affect your ability to walk. Nondisplaced tuberosity avulsion fractures can generally be treated with compressive dressings (e.g., Ace bandage, Aircast; Figure 11), with initial follow-up in four to seven days.2,3,6 Weight bearing and range-of-motion exercises are allowed as tolerated. A 55 year-old woman comes to you with 2 months of right foot pain. A 34-year-old male sustains the closed finger injury shown in Figure A one week ago.