Proximal 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
Fractures of the proximal phalanx can be complex owing to forces exerted on the fracture fragments by a number of muscles and tendons which often result in angular or rotational deformity.
This topic review will discuss fractures of the proximal phalanx. Finger anatomy, other common finger injuries, and thumb injuries are reviewed separately. (See "Finger and thumb anatomy" and "Distal phalanx fractures" and "Extensor tendon injury of the distal interphalangeal joint (mallet finger)".)
Anatomy of special importance to proximal phalanx fractures is described below; a more detailed discussion of finger anatomy is found elsewhere. (See "Finger and thumb anatomy".)
Proximal phalanx fractures are often unstable due to the forces exerted on the fracture fragments by both the intrinsic and extrinsic hand muscles via their respective tendons, which typically cause apex volar angulation (figure 1) . The intrinsic tendons are relaxed when the metacarpal-phalangeal (MCP) joint is flexed, while the extrinsic extensor tendons are relaxed when the wrist is extended.
Both the lumbrical muscles, which originate on the tendons of the flexor digitorum profundus, and the interosseous muscles, which originate on the metacarpals, insert at or near the proximal phalanx (figure 2 and figure 3). The lumbricals are involved in flexion of the metacarpal-phalangeal (MCP) joint and extension of the interphalangeal joints of the fingers. The interossei are involved in finger abduction and adduction. The extensor digitorum tendon runs along the dorsum of the proximal phalanx, while the flexor digitorum profundus and superficialis tendons run along the volar aspect.
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- MECHANISM OF INJURY
- PRESENTATION AND PHYSICAL EXAMINATION
- PROXIMAL THUMB INJURY
- RADIOGRAPHIC EVALUATION
- INDICATIONS FOR REFERRAL
- INITIAL TREATMENT
- Nondisplaced stable fractures
- Displaced or angulated fractures
- DEFINITIVE TREATMENT
- Nondisplaced stable fractures
- Displaced or angulated fractures treated with reduction
- RECOMMENDATIONS FOR RETURN TO WORK OR SPORT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS