Busch fracture

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Busch fracture
Mallet finger, a type of avulsion fracture
Synonyms	Mallet finger fracture
Pronounce	N/A
Specialty	Orthopedic surgery
Symptoms	Pain, swelling, inability to extend the distal phalanx
Complications	Chronic pain, arthritis
Onset	Sudden, following trauma
Duration	Varies, weeks to months
Types	N/A
Causes	Trauma to the finger
Risks	Sports, manual labor
Diagnosis	Physical examination, X-ray
Differential diagnosis	Jersey finger, finger dislocation
Prevention	N/A
Treatment	Splinting, surgery
Medication	NSAIDs for pain
Prognosis	Good with treatment
Frequency	Common in sports injuries
Deaths	N/A

Busch Fracture

A Busch fracture is a specific type of avulsion fracture that occurs at the base of the distal phalanx of a finger. This injury is often associated with a condition known as mallet finger, which results from the disruption of the extensor tendon at the distal interphalangeal joint.

An X-ray showing an avulsion fracture of the finger

Mechanism of Injury

The Busch fracture typically occurs when an external force is applied to the tip of the finger, causing the distal phalanx to flex suddenly while the extensor tendon is under tension. This forceful flexion can lead to the avulsion of a small fragment of bone at the tendon insertion site. The injury is common in sports such as baseball, basketball, and volleyball, where the fingers are frequently exposed to sudden impacts.

Diagram illustrating the mechanism of mallet finger injury

Clinical Presentation

Patients with a Busch fracture typically present with pain, swelling, and an inability to extend the distal phalanx of the affected finger. The finger may appear to droop at the distal interphalangeal joint, a characteristic sign of mallet finger. The injury is often accompanied by tenderness at the site of the fracture.

Diagnosis

Diagnosis of a Busch fracture is primarily based on clinical examination and confirmed with radiography. An X-ray of the affected finger will reveal the avulsion fracture at the base of the distal phalanx. It is important to assess the size of the avulsed fragment and the degree of joint subluxation, as these factors can influence treatment decisions.

Treatment

The treatment of a Busch fracture depends on the size of the avulsed fragment and the degree of joint involvement. Non-surgical management is often preferred, especially for small fractures without significant joint subluxation. This typically involves splinting the distal interphalangeal joint in extension for a period of 6 to 8 weeks to allow for proper healing of the tendon and bone.

A clinical image of a mallet finger injury

In cases where the fracture fragment is large or there is significant joint subluxation, surgical intervention may be necessary. Surgical options include open reduction and internal fixation or the use of specialized splints to maintain joint alignment during healing.

Prognosis

With appropriate treatment, most patients with a Busch fracture can expect a good functional outcome. However, some may experience residual stiffness or a slight extension lag at the distal interphalangeal joint. Early diagnosis and adherence to treatment protocols are crucial for optimal recovery.

A mallet finger injury showing the characteristic droop

See also

• Mallet finger
• Avulsion fracture
• Extensor tendon injuries