Phalangeal Injuries

Ovid: 5-Minute Sports Medicine Consult, The

Phalangeal Injuries
Lt. Col (P) Jeffrey C. Leggit
  • Attempt to reduce dislocations immediately if neurovascular compromise is suspected.
  • All finger phalangeal injuries require radiographic evaluation.
  • Typically results from direct trauma, crushing injury to the distal phalanx
  • High likelihood of concomitant soft tissue injury (ie, nail bed trauma)
  • 10–15% of all sports-related injuries
  • 50% of all hand fractures are distal phalanx fractures.
Risk Factors
Middle finger and thumb are the most commonly affected digits, due to the fact that they tend to be more exposed than the other digits.
Crushing injury
Commonly Associated Conditions
  • Nail bed trauma
  • Soft tissue injury
  • Tendon injuries
  • Dislocations have high risk for concomitant ligamentous injuries/disruptions
  • Posteroanterior (PA), lateral, and oblique radiographs
  • Oblique or spiral fractures may also be associated with malrotation (1)[C].
  • Hand dominance
  • Occupation and/or athletic position
  • Environment surrounding injury (risk of infection)
  • Mechanism of injury
  • Associated symptoms (ie, numbness, tingling)
Physical Exam
  • Pain, swelling, and ecchymosis are common findings.
  • Subungual hematoma frequently encountered with distal phalanx fracture
  • Gross deformity
  • Malrotation (flex distal interphalangeal and proximal interphalangeal while keeping metacarpophalangeal extended; all fingers should point toward scaphoid; if they do not, malrotation is present)
Diagnostic Tests & Interpretation
  • PA, lateral, and oblique radiographs
  • Oblique or spiral fractures may also be associated with malrotation (1)[C].
Diagnostic Procedures/Surgery
Inspection of nail bed for suspected laceration or hematoma
Ongoing Care
  • Buddy tape/splint continuously for 2 wks and then during sporting events for another 4 wks
  • Soft shoe or splint for comfort
Follow-Up Recommendations
Patient Monitoring
  • Fractures that required reduction should be seen within 1 wk and repeat radiographs should be obtained to check for fracture stability.
  • Subungual hematoma: 24 hr
Most heal well, but may remain sensitive for months (3)
  • 826.0 Closed fracture of one or more phalanges of foot
  • 959.5 Other and unspecified injury to finger
  • 959.7 Other and unspecified injury to knee, leg, ankle, and foot

This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Accept Read More