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Phalanx Fractures Hand
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(Redirected from Phalanx Fractures (Hand))
Contents
Other Names
- Finger Fracture
- Distal Phalanx Fracture
- Middle Phalanx Fracture
- Proximal Phalanx Fracture
- Seymour Fracture
- Tuft Fracture
Background
- This page refers to fractures of the 2-3 bones of the finger referred to as Phalanx
- This refers to the ulnar four digits (index, middle, ring and little finger)
- Thumb fractures and metacarpal fractures are discussed separately
History
Epidemiology
- Approximately 10% of all fractures (need citation)
- 5th digit is most commonly affected accounting for 38% of all hand fractures (need citation)
Pathophysiology

Comminuted phalangeal tuft fracture of the third digit. The fracture does not extend into the DIP joint. Soft tissue swelling around the distal digit.[1]

Seymour Fracture. Better characterized as a displaced, angulated physeal fracture with metaphyseal fragment (red arrow), consistent with salter harris II fracture[2]
General
- Very common, however less common than Metacarpal Fractures
- Can be proximal, middle, distal phalanx
- Can occur base, neck, shaft or head
- May be intra- or extra-articular
- Some may not even seek medical attention if non displaced
- Location: Distal > middle > proximal phalanx
Etiology
- Crush
- Sports
- Most common under 29
- Machinery
- Most common age 40 to 69
- Falls
- Most common over 70
Distal Phalanx Fractures & Associated Injuries
- Tuft Fracture
- Crush injury of the distal phalanx
- Typically stable, associated with nailbed lacerations
- Mallet Finger
- Forced flexion of an extended finger with extensor tendon rupture
- Can avulse the proximal aspect of the distal phalanx
- Seymour Fracture
- Distal phalanx fracture associated with nailbed injury and growth plate injury
- Occurs due to hyperflexion
- Presents with mallet deformity
- Occurs due to terminal tendon attaches to proximal epiphyseal fragment, FDP tendon attaches to distal fragment
- Nail Bed Lacerations
- Nail Bed Avulsions
- Subungual Hematoma
Middle/Proximal Phalanx Fractures
- Condyle Fracture
- Also termed a "head fracture", referring to the head or distal aspect of the phalanx
- Neck Fracture
- Salter Harris II Fracture
- Occurs at base of phalanx
- Salter Harris III Fracture, Salter Harris IV Fracture
- Volar Plate Injury
- Hyperextension injury, often from sports following a dislocation
- Can avulse the proximal volar aspect of the distal phalanx
Risk Factors
- Male
Differential Diagnosis
Differential Diagnosis Finger Pain
- Stress Fracture
- Jammed Finger
- Fracture Dislocation
- Gout
- Finger Infection
- Neoplasm
Differential Diagnosis Finger And Hand Pain
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features

Illustration of scissoring on the right with normal on the left. Note that all fingers are parallel and point towards the thenar eminence or scaphoid[3]
History
- Characterize mechanism of injury
- Location of pain, swelling should clue you into injury pattern
- Be certain to clarify hand dominance, baseline function, occupation and hobbies
Physical Exam: Physical Examination Hand
- Inspection may reveal ecchymosis, swelling, deformity
- Important to exclude rotational deformity, open wounds
- Palpation reveals focal tenderness of the affected bone(s)
- Range of motion is often reduced
- Assess for "scissoring" of digits which suggests rotational component
- Radial and ulnar pulse most often normal, check 2-point discrimination
Evaluation
Radiographs
- Standard Radiographs Hand
- First line imaging in all suspected phalanx fractures
- Recommended views: PA, lateral, oblique
- Generally characterizes lesion well
- Proximal phalanx
- Apex volar angulation flexed by interossei, distal fragment extended by central slip
- Middle phalanx
- Apex volar angulation if distal to FDS insertion
- Apex dorsal angulation if proximal to FDS insertion
Ultrasound
- Ultrasound can be used to diagnose phalanx fractures
- Exact role in diagnosis compared to XR is not well defined
MRI/CT
- Generally not needed
- Indications
- Assess articular involvement in uncertain cases
- Rarely, may be indicated in complex or surgical cases
- Evaluate soft tissue injuries in uncertain lesions
Classification
Proximal and Middle Phalanx
- Head fractures
- Type I: stable, no displacement
- Type II: unstable, unicondylar
- Type III: unstable, bicondylar or comminuted
- Neck/shaft fractures
- Short oblique
- Long oblique
- Spiral
- Transverse
- Middle phalanx neck fracture often has apex volar angulation
- Middle phalanx deformity patterns:
- Apex volar angulation: distal to FDS insertion
- Apex dorsal angulation: proximal to FDS insertion
- Without angulation: due to inherent stability provided by an intact and prolonged FDS insertion
- Base fractures
- Extra-articular vs Intra-articular, with or without lateral base
- Middle phalanx deformity is usually apex dorsal angulation
- Proximal fragment in extension (due to central slip)
- Distal fragment in flexion (due to FDS)
- Aan be further classified into
- Partial articular fractures: volar, dorsal or lateral base
- Complete articular fractures: pilon fractures, unstable in all directions
Distal Phalanx
- Tuft fractures
- Crush facture; usually stable; associated with nailbed injuries
- Shaft fractures: transverse vs longitudinal
- Base fractures
- Usually unstable
- Mechanism
- Shearing due to axial load; fracture involving > 20% of articular surface
- Avulsion due tensile force of terminal tendon or FDP; small avulsion fracture
- Further classified into: dorsal or volar base
- Seymour fractures
- Epiphyseal injury of distal phalanx resulting from hyperflexion
Management

Dorsal blocking splint or extension block splint on digits 2 and 3. The splint is fashioned out of fiberglass, taped in place.[3]
Non-operative
- Indications
- Most phalanx fractures are managed nonoperatively
- Tuft Fractures
- Generally includes extra-articular, < 10° angulation, < 2 mm shortening, no rotational deformity
- Intra-articular fractures can be nonoperatively managed if non displaced
- Distal Phalanx
- Finger Splinting for non-displaced fractures, typically with a U-shaped splint
- Immobilize PIP and DIP joints
- Can consider buddy tape
- Proximal Phalanx
- Needs to cover Metacarpophalangeal Joint
- Non-displaced or displaced fractures which have been reduced
- Encourage gentle active range of motion
- Antibiotics
- Consider oral antibiotics for open fractures
Operative
- Indications
- Extra-articular, > 10° angulation, > 2 mm shortening, or with rotational deformity
- Displaced intra-articular fractures
- Unstable or irreducible fracture pattern
- Open fractures
- Technique
- Often uses K-wires or ORIF
- Traction for comminuted fractures
Rehab and Return to Play
Rehabilitation
- Post operative care at discretion of surgeon
Return to Play/ Work
- RTP varies widely
- Largely depends on sport and position
- In general, anticipate 4-6 weeks before returning
- In some sports, can consider playing in a splint or cast if needed
Prognosis and Complications
Prognosis
- Most patients will have good outcomes
Complications
- Nailbed Injuries
- Fracture-dislocations
- Diminished range of motion
- Most common complication (need citation)
- Risk factors: prolonged immobilization, intra-articular fracture, extensive surgical dissection)
- Treatment: aggressive hand therapy, surgical release if not improving
- Malunion
- Types: malrotation, angulation, shortening
- Nonunion
- Uncommon, less than 2% of cases (need citation)
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ Case courtesy of Matt A. Morgan, Radiopaedia.org, rID: 48240
- ↑ Case courtesy of Francis Deng, Radiopaedia.org, rID: 71967
- ↑ 3.0 3.1 Image courtesy of https://www.rch.org.au/clinicalguide/guideline_index/fractures/, Phalanx Fractures