eMedicine Specialties > Sports Medicine > Wrist and Hand

Phalangeal Fractures: Follow-up

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

Follow-up

Return to Play

Return to play in patients with phalangeal fractures is guided by the patient's symptoms, healing, and potential for reinjury. If the fracture can be adequately protected and immobilized, while not interfering with the patient's ability to participate, then sports participation can be allowed, providing the patient has adequate pain control.

Complications

Phalangeal fractures, as with all fractures, are subject to the risks of delayed union, malunion, and nonunion. These can be the result of inadequate immobilization and patient noncompliance with immobilization.

Prognosis

Most phalangeal fractures heal without significant complications. Fractures that involve a joint are more prone to prolonged stiffness and decreased range of motion.

Miscellaneous

Medicolegal Pitfalls

  • When splinting the mallet finger, 2 potential pitfalls should be avoided:
    • The DIP joint should not be severely hyperextended, because subsequent ischemia and necrosis of the dorsal tissue may occur.
    • If the PIP joint is splinted, then thickening of the collateral ligaments may occur, resulting in joint contracture and stiffness with a longer rehabilitation course.
  • It is not recommended to use splint immobilization for stable palmar lip fractures, because this can lead to stiffness and persistent flexion contractures.
  • With regard to the PIP joint after fracture-dislocation, flexion contracture occurs if immobilization is in excessive flexion and dynamic splinting is done after 6 weeks.
 


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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