Differential Diagnosis for Undisplaced Acute Comminuted Crush Fracture of the Distal Phalanx
- Single Most Likely Diagnosis
- Tuft fracture of the distal phalanx: This is the most likely diagnosis given the description of an undisplaced acute comminuted crush fracture of the distal phalanx without evident articular extension. The tuft of the distal phalanx is prone to such injuries due to its exposed position and the forces applied during a crush injury.
- Other Likely Diagnoses
- Mallet finger: Although typically associated with a loss of active extension at the distal interphalangeal joint, a mallet finger could potentially present with a comminuted fracture if the injury is severe enough. However, the absence of articular extension makes this less likely.
- Subungual hematoma: This condition could result from a similar mechanism of injury and might be considered if there's significant bleeding under the nail. However, it doesn't directly relate to a comminuted fracture unless the fracture caused the hematoma.
- Do Not Miss Diagnoses
- Osteomyelitis (infection of the bone): Although not immediately apparent, any open fracture or significant trauma to the distal phalanx could potentially introduce bacteria into the bone or surrounding tissue, leading to infection. Early recognition and treatment are crucial.
- Compartment syndrome: This is a serious condition that could arise from significant trauma to the hand or fingers, including crush injuries. It's characterized by increased pressure within a confined space, which can lead to muscle and nerve damage.
- Rare Diagnoses
- Avascular necrosis of the distal phalanx: While more commonly associated with fractures of the proximal pole of the scaphoid or the femoral head, any significant trauma to the distal phalanx could potentially compromise its blood supply, leading to avascular necrosis.
- Pathological fracture: If the patient has an underlying bone disease (e.g., osteoporosis, bone cysts, or tumors), a relatively minor trauma could result in a comminuted fracture of the distal phalanx. This would be less common but important to consider, especially in patients with known risk factors.