Differential Diagnosis for Smashed Middle Finger

• Single most likely diagnosis
  • Closed fracture of the middle finger: This is the most likely diagnosis due to the direct trauma to the finger, which can cause a break in one or more of the bones.
• Other Likely diagnoses
  • Soft tissue injury (contusion, laceration, or sprain): The force of the smash could also damage the surrounding soft tissues, including skin, tendons, and ligaments.
  • Dislocation of the middle finger: The trauma could cause the bones in the finger to become misaligned, leading to a dislocation.
  • Crush injury: Depending on the force and nature of the smash, there could be a crush injury affecting multiple tissues and structures in the finger.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Compartment syndrome: Although less common, compartment syndrome is a serious condition that can occur after a crush injury, where increased pressure within the compartments of the finger can lead to nerve and muscle damage.
  • Vascular injury: Damage to the blood vessels supplying the finger could lead to ischemia and potentially gangrene if not promptly addressed.
  • Open fracture: If the skin is broken and the bone is exposed, it's considered an open fracture, which has a higher risk of infection and requires immediate medical attention.
• Rare diagnoses
  • Infection (e.g., tetanus): While less likely immediately after the injury, if the wound becomes contaminated, there's a risk of infection, including tetanus.
  • Nerve damage: Direct trauma to the nerves in the finger could result in numbness, tingling, or permanent nerve damage.
  • Osteonecrosis: In rare cases, the blood supply to the bone could be compromised, leading to the death of bone tissue.