"Demystifying Phalanx Fractures: Causes, Types, and Treatment Options

Discover the causes, types, and treatment options available for phalanx fractures. Get expert insights on managing these common hand injuries and regaining motion.

Epidemiology

Phalanx fractures are among the most common injuries to the skeletal system, accounting for approximately 10% of all fractures. They are more common in males, with a male-to-female ratio of 2:1. Distal phalanx fractures are the most common, followed by middle and proximal phalanx fractures. The small finger is the most commonly affected, accounting for 38% of all hand fractures.

Etiology

The mechanism of injury for phalanx fractures depends on the age of the individual. Sports-related injuries are most common in individuals aged 10-29 years, while machinery-related injuries are most common in individuals aged 40-69 years. Falls are the most common cause of phalanx fractures in individuals over 70 years old. Phalanx fractures are often associated with nail bed injuries.

Anatomy

Osteology

The distal phalanx consists of four components: the tuft, shaft, base, and apex. The middle and proximal phalanxes also have four components: the head, neck, shaft, and base. Displacement of a middle phalanx fracture can occur dorsally or volarly, depending on the location of the fracture with respect to the flexor digitorum superficialis (FDS) insertion. Displacement of a proximal phalanx fracture usually results in volar apex.

Arthrology

The interphalangeal joint is a hinge joint that provides dynamic stability during pinch and grip. Passive stability is provided by collateral ligaments. The tendons involved in phalanx fractures include the terminal extensor tendon, flexor digitorum profundus (FDP), central slip, and flexor digitorum superficialis (FDS).

Blood Supply

The proper digital arteries are the dominant arteries found on the median side of the phalanges. They play a crucial role in the blood supply to the fingers.

Nervous System

The proper digital nerves are located volar to the proper digital arteries and are responsible for the sensory innervation of the digits.

Biomechanics

The interphalangeal joint is subjected to compressive forces during pinch and grip, providing dynamic stability. Passive stability is provided by the collateral ligaments.

Classification

Phalanx fractures can be classified based on their location and fracture type.

Descriptive

Proximal phalanx fractures can be divided into head fractures, neck/shaft fractures, and base fractures. Middle phalanx fractures can also be divided into head fractures, neck fractures, shaft fractures, and base fractures. Displaced fractures are further classified based on angulation and involvement of articular surfaces.

Distal phalanx Classification

Distal phalanx fractures can be classified as tuft fractures, shaft fractures, or base fractures. Base fractures of the distal phalanx can be subclassified as volar base or dorsal base fractures. Seymour fractures refer to epiphyseal injuries of the distal phalanx.

Presentation

History

The patient's hand dominance, baseline hand function, occupation, hobbies, and mechanism of injury should be considered in the history.

Physical Exam

The physical exam should include inspection for swelling, ecchymosis, deformity, and open wounds. Assessment of motion and neurovascular status is also important.

Imaging

Radiographs are recommended to confirm the diagnosis of phalanx fractures. Recommended views include PA, lateral, and oblique. CT scans may be necessary to assess articular involvement.

Diagnosis

The diagnosis of phalanx fractures is confirmed based on history, physical exam, and radiographic findings.

Treatment

Proximal Phalanx Fractures

Nonoperative

Extraarticular fractures with minimal angulation or shortening and nondisplaced intraarticular fractures may be treated with buddy taping or splinting. Immobilization is followed by aggressive motion therapy.

Operative

Operative treatment includes closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) for unstable or displaced fractures.

Middle Phalanx Fractures

Nonoperative

Extraarticular fractures with minimal angulation or shortening and nondisplaced intraarticular fractures may be treated with buddy taping or splinting. Immobilization is followed by aggressive motion therapy.

Operative

Operative treatment includes closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) for unstable or displaced fractures.

Distal Phalanx Fractures

Nonoperative

Most distal phalanx fractures can be managed with closed reduction and splinting.

Operative

Operative treatment may be necessary for displaced or irreducible fractures, fractures with nail bed injuries, or fractures with significant articular involvement. Surgical techniques include closed reduction and percutaneous pinning (CRPP), nail bed repair, and open reduction and internal fixation (ORIF).

Complications

Complications of phalanx fractures include loss of motion, malunion, and nonunion. Rehabilitation with hand therapy is crucial for regaining motion. Malunions may require corrective osteotomy, while nonunions may require surgical intervention such as resection and bone grafting.

Conclusion

Phalanx fractures are common hand injuries that can be effectively managed with proper diagnosis and treatment. Understanding the epidemiology, anatomy, and treatment options for phalanx fractures is essential for optimal patient outcomes.

Epidemiology
Phalanx fractures are among the most common injuries to the skeletal system, accounting for approximately 10% of all fractures. They are more common in males, with a male-to-female ratio of 2:1. Distal phalanx fractures are the most common, followed by middle and proximal phalanx fractures. The small finger is the most commonly affected, accounting for 38% of all hand fractures.

Etiology
The mechanism of injury for phalanx fractures depends on the age of the individual. Sports-related injuries are most common in individuals aged 10-29 years, while machinery-related injuries are most common in individuals aged 40-69 years. Falls are the most common cause of phalanx fractures in individuals over 70 years old. Phalanx fractures are often associated with nail bed injuries.

Anatomy

Osteology The distal phalanx consists of four components: the tuft, shaft, base, and apex. The middle and proximal phalanxes also have four components: the head, neck, shaft, and base. Displacement of a middle phalanx fracture can occur dorsally or volarly, depending on the location of the fracture with respect to the flexor digitorum superficialis (FDS) insertion. Displacement of a proximal phalanx fracture usually results in volar apex. Arthrology The interphalangeal joint is a hinge joint that provides dynamic stability during pinch and grip. Passive stability is provided by collateral ligaments. The tendons involved in phalanx fractures include the terminal extensor tendon, flexor digitorum profundus (FDP), central slip, and flexor digitorum superficialis (FDS). Blood Supply The proper digital arteries are the dominant arteries found on the median side of the phalanges. They play a crucial role in the blood supply to the fingers. Nervous System The proper digital nerves are located volar to the proper digital arteries and are responsible for the sensory innervation of the digits. Biomechanics The interphalangeal joint is subjected to compressive forces during pinch and grip, providing dynamic stability. Passive stability is provided by the collateral ligaments.

Classification

Phalanx fractures can be classified based on their location and fracture type. Descriptive Proximal phalanx fractures can be divided into head fractures, neck/shaft fractures, and base fractures. Middle phalanx fractures can also be divided into head fractures, neck fractures, shaft fractures, and base fractures. Displaced fractures are further classified based on angulation and involvement of articular surfaces. Distal phalanx Classification Distal phalanx fractures can be classified as tuft fractures, shaft fractures, or base fractures. Base fractures of the distal phalanx can be subclassified as volar base or dorsal base fractures. Seymour fractures refer to epiphyseal injuries of the distal phalanx.

Presentation
History The patient's hand dominance, baseline hand function, occupation, hobbies, and mechanism of injury should be considered in the history. Physical Exam The physical exam should include inspection for swelling, ecchymosis, deformity, and open wounds. Assessment of motion and neurovascular status is also important.

phalanx fractures

causes

types

treatment options

hand injuries

management

motion