Phalanx #

• Most common upper limb fractures (1)
• Divided into (2,3):
  • Proximal phalanx
    • Often comminuted and involving the MCPJ.
    • Neck fractures tend to be unstable.
  • Middle phalanx
    • Middle # tend to be stable due to FDS insertion.
    • Proximal # tend to have a poor functional outcome.
  • Distal phalanx
    • Most common phalanx #, especially the middle finger and the thumb
    • Nail plate/bed commonly involved
    • Be wary of injuries to the flexor/extensor tendon
• Most common mechanism of injury:
  • Children: Shut in door
  • Adult: Workplace injury or sports
• Phalangeal fractures for conservative management (1):
  • If affects only the tuft of distal phalanx
• Phalangeal fractures requiring MUA or Surgery :
  • Rotational deformity
  • Significant dorsal angulation
  • Radial or ulnar angulation +/- scissoring
  • Open or intra-articular fractures
  • Fractures with bone loss or associated NV/tendon injury

Framework (1):

• Open/Closed
• Where?
  • Distal, Middle, Proximal, Thumb, MCPs
• What part of bone?
  • Neck, Shaft, Base
• Associated injuries?
  • Flexor/Extensor Tendons
  • Tendon Sheath
  • Soft tissue damage
    • Nail bed
    • Skin
    • Nerve/Vessel - assess neurovascular status

Imaging

• XR: AP, Lateral, Oblique