Distal phalanx fracture

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 associted 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 communition, and fracture displacement should be assessed when formulating a report.

Fracture rotation can be difficult to assess radiologically and is best assessed on clinical examination. Fractures with significant radiological communition and/or extensive soft tissue injury should be clinically and radiologically reviewed for open fracture.

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.

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.

Fractures
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Article information

rID: 41775
Synonyms or Alternate Spellings:
  • Phalangeal tuft fracture
  • Distal phalangeal fracture

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Cases and figures

  • Case 1: distal phalanx near-amputation
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  • Case 2: with wrist fractures
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  • Case 3: open Salter Harris type 1
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  • Case 4 : thumb distal phalanx fracture
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  • Case 5
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  • Case 6: fracture of distal phalanx of great toe
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