Distal phalanx fractures are among the most common fractures in the hand. 

They represent > 50% of all phalangeal fractures and frequently involve the ungual tuft ¹.

They are frequently related to sports, with lesions such as the mallet finger and the Jersey finger. When associated with a crush injury, open fracture is more likely.

Radiographic features

Plain radiographs form the mainstay of imaging distal phalanx fractures. The presence or absence of an intra-articular component, degree of comminution, and fracture displacement should be assessed when formulating a report.

Fracture angulation can be difficult to assess radiologically and is best assessed on clinical examination.

Treatment and prognosis

The majority of distal phalanx fractures are minimally displaced and may be treated conservatively. Closed fractures are generally stable, especially when they do not involve the articular surface. A mallet splint is often used in these cases.

Fractures at the base of the distal phalanx are often unstable due to the fact these are the insertions sites for both the flexor and extensor tendon, however splinting of these fractures, granted they are closed has favourable outcomes ³. 

As in all cases of trauma, the importance of recognition of open distal phalanx fractures is due to the increased risk of contamination and, hence, infection. Extensive wound irrigation, antibiotic cover, and tetanus booster prophylaxis must be considered to mitigate this risk. Surgery for nailbed repair and/or Kirschner wire fixation will be required in more complex cases.

Extensively comminuted fractures and/or fractures with soft tissue injury to the nail bed should be considered as an open fracture and clinically treated as such (with antibiotics). Failure to do so may result in distal phalanx osteomyelitis, and additional complications such as growth arrest.