Phalanx #

INTRODUCTION

  • 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

ASSESSMENT

Framework (1):

      • Open/Closed
      • Where?
          • Distal, Middle, Proximal, Thumb, MCPs
      • What part of bone?
          • Neck, Shaft, Base
      • Associated injuries?

Imaging

      • XR: AP, Lateral, Oblique

REFERENCES

1. Haughton D, Jordan D, Malahias M, Hindocha S, Khan W. Principles of hand fracture management. Open Orthop J. 2012;6:43–53. 2. Green DP, Wolfe SW. Green’s operative hand surgery. Elsevier/Churchill Livingstone; 2011. 3. Chiu TW. Stone’s Plastic Surgery Facts: A Revision Guide, Fourth Edition. CRC Press; 2018. 4. The British Society of Surgery for the Hand. Hand Injury Triage App [Internet]. [cited 2020 Feb 2]. Available from: handinjurytriageapp.bssh.ac.uk
Header Image: Licensed with Adobe Stock 2019
This subpage has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)