eMedicine Specialties > Sports Medicine > Wrist and Hand

Phalangeal Fractures: Differential Diagnoses & Workup

Author: Jay E Bowen, DO, Assistant Professor, Clinical Coordinator Sports Medicine Fellowship, Department of Physical Medicine and Rehabilitation, Kessler Rehabilitation Corporation
Coauthor(s): Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation; Elena Napolitano, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey; Alice Tzeng, MD, Resident, Resident, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Jan 23, 2009

Differential Diagnoses

Jammed Finger
Phalangeal Fractures

Other Problems to Be Considered

Dislocations
Infection
Ligamentous injury
Soft-tissue injury

Workup

Imaging Studies

  • If a serious injury is suspected, radiographs should be performed before more forceful testing.
    • Most hand fractures are usually detected by obtaining 3 views (ie, anteroposterior [AP], a true lateral, oblique) of the specific injured joint rather than the entire hand.
    • Brewerton views (beam angled 30° from the ulnar side of the hand) can be used to detect collateral ligament avulsion injuries.
    • Direct posterior-anterior (PA) and lateral views of the thumb should be obtained if the thumb is suspected of injury. Fractures of the middle and proximal phalanx may angulate palmar or dorsally.
    • Postreduction radiographs should show no more than 10° of angulation and rotational displacement.
  • When a patient presents with a dorsal dislocation of the PIP joint, a prereduction radiograph should be obtained to rule out any associating fracture, which could interfere with the attempted reduction.

Procedures

  • If a patient with a suspected phalangeal fracture is having significant discomfort that cannot allow adequate testing, anesthesia with a digital nerve block should be performed.
  • Remember to perform a sensory nerve examination before administering the nerve block.

More on Phalangeal Fractures

Overview: Phalangeal Fractures
Differential Diagnoses & Workup: Phalangeal Fractures
Treatment & Medication: Phalangeal Fractures
Follow-up: Phalangeal Fractures
References
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References

  1. Ruby LK. Common hand injuries in the athlete. Orthop Clin North Am. Oct 1980;11(4):819-39. [Medline].

  2. Hoffman DF, Schaffer TC. Management of common finger injuries. Am Fam Physician. May 1991;43(5):1594-607. [Medline].

  3. Mastey RD, Weiss AP, Akelman E. Primary care of hand and wrist athletic injuries. Clin Sports Med. Oct 1997;16(4):705-24. [Medline].

  4. Aitken S, Court-Brown CM. The epidemiology of sports-related fractures of the hand. Injury. Dec 2008;39(12):1377-83. [Medline].

  5. Belsky MR, Eaton RG, Lane LB. Closed reduction and internal fixation of proximal phalangeal fractures. J Hand Surg [Am]. Sep 1984;9(5):725-9. [Medline].

  6. Wilson RL, McGinty LD. Common hand and wrist injuries in basketball players. Clin Sports Med. Apr 1993;12(2):265-91. [Medline].

  7. Klein DM, Belsole RJ. Percutaneous treatment of carpal, metacarpal, and phalangeal injuries. Clin Orthop Relat Res. Jun 2000;375:116-25. [Medline].

  8. Bowers AL, Baldwin KD, Sennett BJ. Athletic hand injuries in intercollegiate field hockey players. Med Sci Sports Exerc. Dec 2008;40(12):2022-6. [Medline].

  9. Khalid M, Theivendran K, Cheema M, Rajaratnam V, Deshmukh SC. Biomechanical comparison of pull-out force of unicortical versus bicortical screws in proximal phalanges of the hand: a human cadaveric study. Clin Biomech (Bristol, Avon). Nov 2008;23(9):1136-40. [Medline].

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Further Reading

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Keywords

phalangeal fractures, finger injuries, hand injuries, extra-articular fractures, crush injuries, intra-articular fractures, mallet fracture, jersey fracture, proximal interphalangeal joint, PIP joint, distal phalangeal fractures, middle phalangeal fractures, proximal phalangeal fractures, dorsal PIP joint dislocations, volar PIP joint dislocations, Boutonniere deformities

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Contributor Information and Disclosures

Author

Jay E Bowen, DO, Assistant Professor, Clinical Coordinator Sports Medicine Fellowship, Department of Physical Medicine and Rehabilitation, Kessler Rehabilitation Corporation
Jay E Bowen, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Elena Napolitano, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey
Disclosure: Nothing to disclose.

Alice Tzeng, MD, Resident, Resident, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

Andrew D Perron, MD, Residency Director, Department of Emergency Medicine, Maine Medical Center
Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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