Differential Diagnosis for Minimally Comminuted and Minimally Displaced Acute Fracture of the Third Distal Phalangeal Tuft
- Single most likely diagnosis
- Closed fracture of the distal phalanx with associated nail bed laceration: This is the most straightforward diagnosis given the description of a minimally comminuted and minimally displaced fracture with a laceration extending into the nail, suggesting a direct injury to the nail bed and the underlying bone.
- Other Likely diagnoses
- Open fracture of the distal phalanx: Although the question specifies "acute fracture" without explicitly stating it's open, the presence of a laceration extending into the nail could imply an open fracture, especially if the laceration communicates with the fracture site.
- Subungual hematoma: This condition could occur alongside a fracture and is suggested by the laceration extending into the nail, which might lead to blood accumulation under the nail.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Osteomyelitis (infection of the bone): Although less likely at the initial presentation, any open fracture or significant soft tissue injury increases the risk of infection. Early recognition and treatment are crucial to prevent long-term complications.
- Compartment syndrome: This is a serious condition that could arise from significant soft tissue injury and swelling within a closed compartment, leading to increased pressure and potential nerve and muscle damage.
- Rare diagnoses
- Malignancy (e.g., osteosarcoma, chondrosarcoma): While extremely rare in the context of an acute injury, any unexplained or unusual fracture, especially in the absence of significant trauma, might warrant further investigation to rule out an underlying pathological process.
- Infection with unusual organisms (e.g., tetanus): Given the presence of a wound, there's a small risk of infection with unusual organisms, especially if the wound was contaminated with soil or other materials that might harbor such pathogens.