The Common Vein Copyright 2011
Definition
Fractures of the phalanges are usually caused by direct trauma or a stubbing injury. Avulsion fractures can occur.
The fractures are classified by location, angulation, displacement, comminution, intraarticular involvement, presence of fracture-dislocation. The possible locations for fractures include the proximal, middle, and distal phalanx.
A “mallet finger” is an avulsion injury of the extensor tendon with a fracture of the dorsal lip.
A “jersey finger” is an avulsion injury of the flexor digitorum profundus rupture with volar lip involvement.
The fracture may be complicated in the acute phase by neurovascular injury, or in the subacute or chronic phases by nonunion, malunion, infection, osteonecrosis, or osteoarthritis.
The diagnosis of this injury is usually made by a combination of physical examination and x-ray imaging.
Imaging includes the use of plain x-rays, and if indicated CT-scan, or MRI.
Treatment for most phalangeal fractures is with splinting. ORIF can be performed for displaced fractures.
A “mallet finger” is treated with 6 to 8 weeks of extension splinting or closed reduction internal fixation with pins.
A “jersey finger” is treated with primary repair of the large, displaced bony fragments.
Normal AP Examination and Nomenclature |
| Courtesy Ashley Davidoff MD 45737d03 |
This A-P examination of the right hand of a 24 year old male shows a simple oblique fracture of the shaft of the 4th proximal phalanx with near anatomic alignment. The fracture line is overlaid in black in image b. Mild soft tissue swelling is present
Courtesy Ashley Davidoff TheCommonVein.net 99941.8cL
Avulsion Fracture of the Distal Phalanx |
| Courtesy Ashley Davidoff MD 49456b01 |
Laceration Fracture of the Distal Phalanx of the Thumb |
| Courtesy Ashley Davidoff MD 70179.800 |
References
Davis MF, Davis PF, Ross DS. Expert Guide to Sports Medicine. ACP Series, 2005.
Elstrom J, Virkus W, Pankovich (eds), Handbook of Fractures (3rd edition), McGraw Hill, New York, NY, 2006.
Koval K, Zuckerman J (eds), Handbook of Fractures (3rd edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.
Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.