Phalanx Fractures



Phalanx Fractures


Joseph A. Rosenbaum

Hisham M. Awan



INTRODUCTION



  • 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.


EVALUATION



  • 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


ACUTE MANAGEMENT



  • 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.)


DEFINITIVE TREATMENT

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