Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Distal phalanx fractures

Rebecca Bassett, MD
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


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".)


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).

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:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 13, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Bendre AA, Hartigan BJ, Kalainov DM. Mallet finger. J Am Acad Orthop Surg 2005; 13:336.
  2. Capo JT, Hastings H 2nd. Metacarpal and phalangeal fractures in athletes. Clin Sports Med 1998; 17:491.
  3. Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg 1993; 27:317.
  4. Eiff MP, Hatch R, Calbach W. Finger fractures. In: Fracture Management for Primary Care, 2nd, Saunders, Philadelphia 2003. p.49.
  5. Amadio PC, Pawlina W, Carmichael SW. Clinical anatomy of the distal phalanx. Clin Anat 2001; 14:389.
  6. Wheeless Orthopaedics Online. Distal Phalangeal Fractures. www.wheelessonline.com/ortho/distal_phalangeal_fractures (Accessed on March 01, 2007).
  7. Schriger DL, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med 1988; 17:932.
  8. Gaston RG, Chadderdon C. Phalangeal fractures: displaced/nondisplaced. Hand Clin 2012; 28:395.
  9. 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.
  10. Hardy MA. Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts. J Orthop Sports Phys Ther 2004; 34:781.
  11. 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.
  12. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med 2008; 1:97.
  13. 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.
  14. Cannon NM. Rehabilitation approaches for distal and middle phalanx fractures of the hand. J Hand Ther 2003; 16:105.
  15. DaCruz DJ, Slade RJ, Malone W. Fractures of the distal phalanges. J Hand Surg Br 1988; 13:350.