Middle 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
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Finger fractures are among the most common injuries 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.
Fractures of the middle phalanx are discussed here. Finger anatomy, other common finger injuries, and thumb injuries are reviewed separately. (See "Distal phalanx fractures" and "Proximal phalanx fractures" and "Extensor tendon injury of the distal interphalangeal joint (mallet finger)" and "Flexor tendon injury of the distal interphalangeal joint (jersey finger)" and "Digit dislocation reduction" and "Evaluation of the patient with thumb pain" and "Finger and thumb anatomy".)
Anatomy of special importance to middle phalanx fractures is described below; a more detailed discussion of finger anatomy is found elsewhere. (See "Finger and thumb anatomy".)
The proximal interphalangeal (PIP) joint and the distal interphalangeal (DIP) joint form the articulations of the middle phalanx (figure 1 and figure 2). At the PIP joint, the biconcave base of the middle phalanx articulates with the convex head of the proximal phalanx. These joints are stabilized by a volar plate, extensor apparatus, capsule, and collateral ligaments. Just proximal to the PIP joint, the flexor digitorum superficialis tendon splits to allow for the flexor digitorum profundus (FDP) to travel through its center (figure 3). The FDP then passes along the palmar surface of the middle phalanx and attaches to the distal phalanx. The FDP enables DIP joint flexion.
The flexor digitorum superficialis (FDS) attaches to the palmar surface of the middle phalanx and is the primary flexor of the PIP joint. The deforming forces that act on the middle phalanx fractures are the FDS and the intrinsic tendons. Middle phalangeal fractures proximal to the FDS insertion have an apex dorsal angulation, whereas fractures distal to the FDS insertion have an apex volar angulation as shown in the figure (figure 4). Deep to the flexor tendons the volar plate provides stability against hyperextension.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Blazar PE, Steinberg DR. Fractures of the proximal interphalangeal joint. J Am Acad Orthop Surg 2000; 8:383.
- Yoong P, Johnson CA, Yoong E, Chojnowski A. Four hand injuries not to miss: avoiding pitfalls in the emergency department. Eur J Emerg Med 2011; 18:186.
- Eiff P, Hatch R, Calmbach W. Finger fractures. In: Fracture Management for Primary Care, 2nd, Saunders, Philadelphia 2003. p.49.
- Freiberg A, Pollard BA, Macdonald MR, Duncan MJ. Management of proximal interphalangeal joint injuries. J Trauma 1999; 46:523.
- Schriger DL, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med 1988; 17:932.
- Henry M. Fractures and dislocations of the hand. In: Rockwood and Green's Fractures in Adults, 5th, Bucholz RW, Heckman JD (Eds), Lippincott Williams & Wilkins, Philadelphia 2002.
- Kozin SH, Thoder JJ, Lieberman G. Operative treatment of metacarpal and phalangeal shaft fractures. J Am Acad Orthop Surg 2000; 8:111.
- Khouri JS, Bloom JM, Hammert WC. Current trends in the management of proximal interphalangeal joint injuries of the hand. Plast Reconstr Surg 2013; 132:1192.
- Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med 2008; 1:97.
- Capo JT, Hastings H 2nd. Metacarpal and phalangeal fractures in athletes. Clin Sports Med 1998; 17:491.
- Cannon NM. Rehabilitation approaches for distal and middle phalanx fractures of the hand. J Hand Ther 2003; 16:105.
- Wheeless Textbook of Orthopedics www.wheelessonline.com (Accessed on March 30, 2009).
- Phair IC, Quinton DN, Allen MJ. The conservative management of volar avulsion fractures of the P.I.P. joint. J Hand Surg Br 1989; 14:168.
- Nørregaard O, Jakobsen J, Nielsen KK. Hyperextension injuries of the PIP finger joint. Comparison of early motion and immobilization. Acta Orthop Scand 1987; 58:239.
- Gaine WJ, Beardsmore J, Fahmy N. Early active mobilisation of volar plate avulsion fractures. Injury 1998; 29:589.
- Body R, Ferguson CJ. Best evidence topic report. Early mobilisation for volar plate avulsion fractures. Emerg Med J 2005; 22:505.
- McCue FC 3rd, Meister K. Common sports hand injuries. An overview of aetiology, management and prevention. Sports Med 1993; 15:281.
- Hardy MA. Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts. J Orthop Sports Phys Ther 2004; 34:781.
- Incavo SJ, Mogan JV, Hilfrank BC. Extension splinting of palmar plate avulsion injuries of the proximal interphalangeal joint. J Hand Surg Am 1989; 14:659.
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- PRESENTATION AND PHYSICAL EXAMINATION
- RADIOGRAPHIC EVALUATION
- INDICATIONS FOR SURGICAL REFERRAL
- General indications
- Determining stability of base fractures
- Nondisplaced fractures
- Displaced or angulated fractures
- Volar plate avulsion fractures
- Dorsal lip fractures
- RETURN TO SPORT OR WORK
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS