Differential Diagnosis for Tuft Fracture with Base of Nail Up

• Single most likely diagnosis:
  • Distal phalanx fracture: This is the most likely diagnosis because a tuft fracture is a type of fracture that occurs at the distal end of the phalanx, and the presentation of the nail being up suggests a possible disruption of the nail bed or the bone beneath it.
• Other Likely diagnoses:
  • Subungual hematoma: This condition, characterized by blood accumulation under the nail, can cause the nail to separate from the nail bed and could be associated with a fracture if the injury was severe enough.
  • Nail bed laceration: An injury severe enough to cause a tuft fracture could also result in a laceration of the nail bed, which might present with the nail being displaced upwards.
• Do Not Miss diagnoses:
  • Open fracture: Although less common, if the skin is broken and the fracture is exposed, it's an open fracture, which requires immediate medical attention to prevent infection.
  • Compartment syndrome: This is a serious condition that can occur after a fracture, where increased pressure within a muscle compartment can lead to muscle and nerve damage. Early recognition is crucial.
• Rare diagnoses:
  • Glomus tumor: A rare, benign tumor of the glomus body that could potentially cause a fracture if it weakened the bone structure over time, though this would be an extremely unusual presentation.
  • Osteomyelitis: An infection of the bone that could weaken it and lead to a fracture, though this would typically be a more chronic process rather than an acute injury presentation.