Diagnostic Assessment — Right Hand Little Finger - Chip Fracture of Middle Phalanx
Example 1 of 1 · fictitious patient (Veteran C)
Diagnostic Assessment
Right Hand Little Finger - Chip Fracture of Middle Phalanx
Balance of Probabilities SOP: Fracture No. 63 of 2024 Reasonable Hypothesis SOP: Fracture No. 64 of 2024
ADF History
The veteran, Communications and Information Systems Controller, enlisted 28 July 1986, discharged 22 Mar 2003.
Occupational History
As a Communications and Information Systems Controller (CISCON), the veteran was exposed to physical training demands, equipment handling, and recreational activities that increased the risk of traumatic injuries. Military training involved contact sports, physical exercises, and activities that could result in falls or direct trauma to the hands during training or recreational periods.
History
The veteran the veteran a CISCON in the RAAF, sustained a chip fracture of the middle phalanx of the little finger in December 1989 during the same incident where he struck a wall, occurring concurrently with his fifth metacarpal fracture.
Timeline
- 22 November 1986: The veteran sustained injury to his right hand after striking a wall, resulting in immediate pain and tenderness affecting multiple areas including the little finger. The traumatic impact caused damage to both the metacarpal and phalangeal bones of the little finger, indicating significant force transmission through the digit.
- 25 November 1986: X-ray examination revealed a chip fracture of the anterior aspect of the base of the middle phalanx of the little finger, identified concurrently with the fifth metacarpal fracture. The chip fracture indicated capsular injury at the proximal interphalangeal joint, demonstrating the extent of trauma sustained during the wall-striking incident.
- 28 November 1986: Orthopedic specialist review confirmed the presence of multiple fractures including the phalangeal chip fracture, describing the injuries as minimal and recommending conservative management with activity modification. The specialist advised avoiding contact sports for 3 weeks while encouraging normal hand use for daily activities.
Symptoms
At the time of injury, the veteran experienced immediate pain and tenderness in the little finger region, particularly affecting the proximal interphalangeal joint area where the chip fracture occurred. The symptoms included localized pain, swelling, and functional limitation of finger movement. Following conservative management, symptoms gradually resolved with restoration of normal finger function, though the structural changes from the healed fracture remained permanent.
Imaging
- 25 November 1986: X-ray findings demonstrated chip fracture of the anterior aspect of the base of the middle phalanx of the little finger
1. What is the formal diagnosis of the condition claimed above?
Right Hand Little Finger - Chip Fracture of Middle Phalanx (S62.606) DVA SOP: Fracture No. 63 of 2024 (Balance of Probabilities), Fracture No. 64 of 2024 (Reasonable Hypothesis) ICD-10 Code: S62.606
A chip fracture is a small fragment of bone that breaks away from the main bone structure, typically occurring at sites of ligament or tendon attachment. A chip fracture of the middle phalanx at the proximal interphalangeal joint commonly results from hyperextension or volar plate avulsion injuries. These fractures indicate capsular injury and represent damage to the joint's stabilizing structures. While often considered minor injuries, they can result in persistent joint stiffness or instability if not properly managed.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms on 22 November 1986 when he struck a wall, causing immediate pain and tenderness affecting the little finger. [MR. ALAN NICHOLLS FRACS FAORTHA, UMR - 200 - 400.pdf, Page 24] [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18]
When did the veteran first present to a health / medical provider for this condition? The veteran first presented for medical assessment on 22 November 1986 following the injury, with clinical evaluation documenting tenderness over the affected finger region. [MR. ALAN NICHOLLS FRACS FAORTHA, UMR - 200 - 400.pdf, Page 24]
When was the condition confirmed / formally diagnosed? The chip fracture was formally diagnosed on 25 November 1986 via X-ray examination, which revealed the fracture of the anterior aspect of the base of the middle phalanx of the little finger. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18]
When did the veteran first present to you (or your practice) for this condition? 31 July 2015.
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed through X-ray imaging on 25 November 1986, which demonstrated a chip fracture of the anterior aspect of the base of the middle phalanx of the little finger. Key symptoms included immediate pain and tenderness in the little finger following the traumatic impact of striking a wall. Clinical examination revealed tenderness over the metacarpophalangeal region and surrounding areas of the little finger. Specialist orthopedic review on 28 November 1986 confirmed the fracture and classified it as minimal, recommending conservative management with activity modification. [WAGGA MEDICAL IMAGING, UMR - 200 - 400.pdf, Page 18] [MR. ALAN NICHOLLS FRACS FAORTHA, UMR - 200 - 400.pdf, Page 24] [SPECIALIST REFERRAL AND REPORT, UMR - 200 - 400.pdf, Page 25]
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Having significant physical force applied to or through the affected bone at the time of clinical onset - This factor requires significant physical force applied to the bone causing the fracture.
- MET: The veteran struck a wall with his fist on 22 November 1986, applying significant physical force that was transmitted through the little finger to the middle phalanx. This direct trauma mechanism is consistent with the typical cause of phalangeal chip fractures and directly resulted in the fracture confirmed by radiological examination.
Inability to obtain appropriate clinical management for fracture before clinical worsening - This factor examines whether appropriate clinical management was available and provided for the fracture.
- NOT MET: The veteran received appropriate and timely clinical management, including prompt X-ray diagnosis within 3 days of injury, orthopedic specialist review, and appropriate conservative management recommendations. There is no evidence of clinical worsening or inadequate management of the fracture.
Sequelae
This condition is not considered a sequelae of another known condition but rather represents a primary traumatic injury occurring concurrently with the fifth metacarpal fracture from the same traumatic event.
Unintended Consequence
The condition is not considered an unintended consequence of medical management, as it resulted from a traumatic incident rather than medical intervention.
Inability to Attain Appropriate Medical Management
The veteran received prompt and appropriate medical management for this fracture. He was assessed within days of the injury, received appropriate X-ray imaging, and had specialist orthopedic review with appropriate conservative management recommendations. The fracture was managed concurrently with the fifth metacarpal fracture using appropriate standards of care for the time. There is no evidence of inability to obtain appropriate clinical management for this condition. As established in Brew v Repatriation Commission (19 July 1990), the veteran had full access to necessary medical care and received treatment consistent with contemporary medical standards.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
