Middle phalanx fractures
- Rebecca Bassett, MD
Rebecca Bassett, MD
- Adjunct Clinical Assistant Professor
- University of North Carolina School of Medicine
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.
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- 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