Proximal phalanx (finger) fracture

Background

• The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity
• Extensor tendons and interosseous muscles commonly causes volar angulation

Workup

• Examine the phalanx with the fingers in full extension and flexion
• Assess for malrotation

Imaging

• AP, lateral, oblique
  • Examine for rotation, shortening, angulation

Differential Diagnosis

Hand and Finger Fracture Types

• Non-thumb metacarpal fractures
  • Head
  • Neck
  • Shaft
  • Base
  • Boxer's fracture
• Thumb fracture
• Finger (Phalanx) Fracture
  • Proximal
  • Middle
  • Distal

Management

• If requires ortho referral: Radial gutter splint or ulnar gutter splint
• Nondisplaced, stable: Consider buddy taping the injured finger to an adjacent finger
  • If the ring finger is involved it should be buddy taped to the little finger
  • Dorsal or volar Finger Splint if desire added protection
• Displaced or angulated fracture
  • Consider closed reduction
    • After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)

Disposition

• Refer for:
  • Intraarticular
  • Unstable
    • Spiral or oblique fracture
    • Condylar fracture
    • Neck fracture
    • Large avulsion fracture
  • Rotated
    • NO degree of rotation is acceptable following a reduction
  • Shortened
  • Significantly angulated
    • Less than 10 degrees may be tolerated

See Also

• Finger (Phalanx) Fracture
• Hand Diagnoses (Main)

References

• UpToDate
• German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.