Phalanx Fractures

Phalanx Fractures

Joseph A. Rosenbaum

Hisham M. Awan


  • Pathoanatomy

    • Fractures of the bones of the fingers typically secondary to trauma

    • Force applied to the affected bone exceeds its strength.

  • Mechanism of injury

    • Mechanisms of injury include crush; torsional, angular, and axial load; and traction.

    • High-energy mechanisms typically cause comminution.

    • Fracture may be part of a more severe overall injury pattern, including soft tissue injury to ligament, joint capsule, tendon, nerve, and/or vessels.

  • Epidemiology

    • Fractures of phalanges and metacarpals are among the most common fractures.

    • Account for approximately 10% of all fractures

    • Common in laborers and athletes

    • Males are affected more than females.


  • History

    • Typically caused by trauma, either direct or indirect

    • Rarely can be pathologic fractures with minimal or no antecedent trauma

    • Presentation may be delayed—Patients may dismiss as a “jammed finger” or sprain.

    • Often overlooked initially in polytrauma cases

  • Physical examination

    • Assess for edema, angular deformity, rotational deformity, and quality of soft tissues.

    • Assess sensation and capillary refill distally.

    • Assess the other digits as well as the hand and wrist.

    • Test for tendon function individually for each finger (flexor digitorum superficialis, flexor digitorum profundus, extensor digitorum communis).

  • Imaging

    • Obtain finger radiograph initially if fracture is suspected.

    • Proximal, middle, distal phalanx (P1, P2, P3)

    • Open versus closed (Nail bed injury with concomitant P3 fracture is considered an open fracture.)

    • Intra-articular versus extra-articular

    • Stable versus unstable fracture pattern

      • Comminuted versus simple (Simple are generally more stable.)

      • Transverse versus oblique (Transverse are more length-stable.)

    • Angulation (P1 tends to be apex volar, P2 apex dorsal.)

    • Translation

    • Presence or absence of foreign bodies

  • Classification

    • Proximal phalanx

      • Articular fractures

      • Pilon fractures

      • Phalangeal shaft

      • Phalangeal neck

      • Unicondylar fractures

      • Bicondylar fractures

    • Middle phalanx fractures

    • Distal phalanx fractures


  • Emergency room management

    • Assess for other injuries.

    • Comfort measures—pain control, elevation, and splinting (Remove splints for radiograph.)

    • Remove patient’s gloves, rings, and jewelry.

    • Elevate, apply ice.

    • Radiographs (Order finger radiograph; order hand radiograph if additional injuries are suspected.)


May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Phalanx Fractures
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