A 55 yo female with a high BMI presents with left fifth toe pain and obvious deformity after trip and fall.  She has no wounds.  An x-ray of the affected toe is shown.  What's the diagnosis?  Scroll down for answer.

Answer:  Closed displaced fracture of the left fifth proximal phalanx

Phalanx fractures:

• proximal phalanx fracture of the of the 5th toe is the second most common toe fracture
• nondisplaced fractures of the 2nd-5th phalanges can be treated with buddy taping and hard soled shoe
• nondisplaced fractures do not require orthopedic (or podiatry) follow up
• displaced fractures should ve reduced in the ED using a digital block and manual reduction or finger trap, followed by buddy taping and hard soled shoe
• displaced fractures require orthopedic (or podiatry) follow up
• many fractures area associated with subungal hematoma; hematomas covering >50% of the nail bed should be treated with trephination
• nondisplaced great toe fractures require a posterior splint; displaced and comminuted great toe fractures reduction and posterior splint, eventual walking cast
• all great toe fractures require orthopedic (or podiatry) follow up

References

Hanlon, Dennis, and Christopher Morris. "Foot." Simon's Emergency Orthopedics, 8e Ed. Scott C. Sherman. New York, NY: McGraw-Hill, 2019.

Leuck, JoAnna, and Tyler Hedman. "Toe Fracture Management." Reichman's Emergency Medicine Procedures, 3e Ed. Eric F. Reichman. New York, NY: McGraw-Hill, 2019.