Distal phalanx fractures
- Rebecca Bassett, MD
Rebecca Bassett, MD
- Adjunct Clinical Assistant Professor
- University of North Carolina School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
Finger fractures are among the most common fractures managed by primary care and emergency clinicians. An understanding of basic finger anatomy and common injury patterns provides the basis for diagnosing and treating these injuries.
This topic review will discuss fractures of the distal phalanx. Finger anatomy and other common finger injuries are reviewed elsewhere. (See "Extensor tendon injury of the distal interphalangeal joint (mallet finger)" and "Management of fingertip injuries" and "Subungual hematoma" and "Middle phalanx fractures" and "Finger and thumb anatomy".)
EPIDEMIOLOGY AND INJURY LOCATION
Distal phalanx fractures represent common sports and work-related injuries, accounting for approximately half of all hand fractures [1-3]. These fractures are commonly caused by trauma or crush injuries. The middle finger is most often affected, followed by the thumb. The distal metaphysis, which anchors the complex nail matrix and nail plate, is often affected by distal fractures.
Anatomy of special importance to distal phalanx fractures is described below. A more detailed discussion of finger anatomy is found elsewhere. (See "Finger and thumb anatomy".)
The range of motion of the distal phalanx is limited in flexion by the flexor digitorum profundus, while extension is limited by the extensor terminal slip. The terminal slip of the extensor tendon inserts on the dorsal surface of the distal phalanx, while the flexor digitorum profundus (FDP) inserts at the volar base of the distal phalanx [4,5]. The FDP tendon causes the distal phalanx to flex after avulsion of the extensor tendon (creating a classic "mallet" deformity). Multiple fibrous septa attach the tuft of the distal phalanx to the volar skin. This contributes to bony stability and minimizes displacement with distal phalanx fractures (figure 1 and figure 2). The nail matrix is the tissue under the nail that permits nail growth and migration. Its longitudinal fibers anchor the dermis to the periosteum of the distal phalanx (figure 3 and picture 1 and figure 4).
- Bendre AA, Hartigan BJ, Kalainov DM. Mallet finger. J Am Acad Orthop Surg 2005; 13:336.
- Capo JT, Hastings H 2nd. Metacarpal and phalangeal fractures in athletes. Clin Sports Med 1998; 17:491.
- Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg 1993; 27:317.
- Eiff MP, Hatch R, Calbach W. Finger fractures. In: Fracture Management for Primary Care, 2nd, Saunders, Philadelphia 2003. p.49.
- Amadio PC, Pawlina W, Carmichael SW. Clinical anatomy of the distal phalanx. Clin Anat 2001; 14:389.
- Wheeless Orthopaedics Online. Distal Phalangeal Fractures. www.wheelessonline.com/ortho/distal_phalangeal_fractures (Accessed on March 01, 2007).
- Schriger DL, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med 1988; 17:932.
- Gaston RG, Chadderdon C. Phalangeal fractures: displaced/nondisplaced. Hand Clin 2012; 28:395.
- Henry M. Fractures and dislocations of the hand. In: Rockwood and Green's Fractures in Adults, 9th, Bucholz RW, Heckman JD (Eds), Lippincott Williams & Wilkins, Philadelphia 2002. p.655.
- Hardy MA. Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts. J Orthop Sports Phys Ther 2004; 34:781.
- Stevenson J, McNaughton G, Riley J. The use of prophylactic flucloxacillin in treatment of open fractures of the distal phalanx within an accident and emergency department: a double-blind randomized placebo-controlled trial. J Hand Surg Br 2003; 28:388.
- Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med 2008; 1:97.
- Chaffin TH. Phalangeal fractures. In: Emergency and Primary Care of the Hand, Hart RG, Uehara DT, Wagner MJ (Eds), American College of Emergency Physcians, Dallas 2001. p.111.
- Cannon NM. Rehabilitation approaches for distal and middle phalanx fractures of the hand. J Hand Ther 2003; 16:105.
- DaCruz DJ, Slade RJ, Malone W. Fractures of the distal phalanges. J Hand Surg Br 1988; 13:350.
- EPIDEMIOLOGY AND INJURY LOCATION
- MECHANISM OF INJURY
- SYMPTOMS AND PHYSICAL EXAMINATION
- RADIOGRAPHIC EVALUATION
- INDICATIONS FOR SURGICAL REFERRAL
- Initial treatment
- Prophylactic antibiotics
- RETURN TO WORK OR SPORT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS