Phalanx fractures are common injuries, although less common than metacarpal fractures. They have different prognosis and treatment depending on the location of the fracture.
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Pathology
Phalanx fractures can be intra or extra-articular and can occur at the base, neck, shaft or head of the phalanx. They often result from direct trauma to the finger (e.g. during ball sports). Crush injuries to the distal phalanx are also common and can result in nail trauma and open fractures.
Fracture-dislocations are possible when the fracture extends to the articular surface of the phalanx.
Radiographic features
Plain radiograph
The plain radiographic investigation of the fingers involves three projections (AP oblique and lateral).
Ultrasound
It is possible to diagnose phalanx fractures with sonography using a linear probe, although it is not the first line (patient discomfort, difficult to read, hard to determine displacement). However, when radiography is unsure about the diagnosis, it is a potentially useful tool.
Treatment and prognosis
Non-operative management
Non-operative treatment is generally the choice of treatment for fractures of the distal phalanx because of the small size. Conservative treatment with splints is used for non-displaced fractures immobilizing the proximal and distal interphalangeal joints (but not the metacarpophalangeal). After that tape can be used if there is still some pain.
For proximal fractures, the splint needs to be longer and immobilize the metacarpophalangeal joint and the wrist. It can be used for non-displaced fractures and for displaced fractures after orthopedic reduction and testing of stability.
Operative management
Surgical treatment of displaced proximal phalanx fracture after reduction is common because of instability and rotation trouble. It involves Kirchner wires by percutaneous pinning or open reduction, or very small screws and plates. Comminuted fractures are difficult to treat and need wires in traction.
Open fractures need urgent evaluation and treatment with tetanus prophylaxis and antibiotic therapy.
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