Proximal phalanx fractures

Case contributed by Leonardo Lustosa


Crush injury to the right hand.

Patient Data

Age: 14 years
Gender: Male

Hand radiographs revealed fractures of the 2nd, 3rd, and 4th proximal phalanxes. The 2nd phalanx is minimally displaced to the ulnar side. The 3rd and 4th phalanxes are volarly displaced.

The fracture line of the 3rd phalanx extends from the metaphysis into the physics, characterizing a Salter-Harris type III fracture.

Case Discussion

Proximal phalanx fractures result from torsional or angular forces combined with axial loadings, such as when catching a ball.

Crush injuries are more commonly related to distal phalanx fractures, such as when hammering oneself's finger. In this case, the patient accidentally dropped a heavy object onto his right hand.

The Salter-Harris classification is used to describe physeal fractures. The classification can be remembered using the SALTR mnemonic:

  • S: slipped (type I)
  • A: above or away from joint (type II)
  • L: lower (type III)
  • T: through or transverse or together (type IV)
  • R: ruined or rammed (type V)

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