Fracture through congenitally fused 5th phalanges

Case contributed by Matt Skalski


Dropped object on foot. Toe pain.

Patient Data

Age: 20
Gender: Male

A transverse, but slightly oblique lucent fracture line is present at the mid-portion of the congenitally fused middle and distal phalanges of the 5th digit. The fracture is non-displaced, without significant comminution or angulation. The soft tissues of the 5th toe are mildly swollen. 

Zoomed and cropped images of the fracture, with arrows indicating the fracture line. Note the lack of smooth corticated boarders that would be expected with a normal articular interface. 

Case Discussion

Congenital fusion of the 5th middle and distal phalanges is a remarkably common phenomenon. This finding is never much of a diagnostic dilemma or of clinical concern, except in the rare cases where the 5th digit has been traumatized, when one must distinguish between a fracture and a normal unfused articular interface. In this case, the fracture line is somewhat oblique, without the smooth corticated margins which round at the margins, as one would expect with normal synovial joint. 

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