Phalangeal Fractures Workup
- Author: Jay E Bowen, DO; Chief Editor: Craig C Young, MD more...
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.
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.
Ruby LK. Common hand injuries in the athlete. Orthop Clin North Am. 1980 Oct. 11(4):819-39. [Medline].
Hoffman DF, Schaffer TC. Management of common finger injuries. Am Fam Physician. 1991 May. 43(5):1594-607. [Medline].
Mastey RD, Weiss AP, Akelman E. Primary care of hand and wrist athletic injuries. Clin Sports Med. 1997 Oct. 16(4):705-24. [Medline].
Aitken S, Court-Brown CM. The epidemiology of sports-related fractures of the hand. Injury. 2008 Dec. 39(12):1377-83. [Medline].
Belsky MR, Eaton RG, Lane LB. Closed reduction and internal fixation of proximal phalangeal fractures. J Hand Surg [Am]. 1984 Sep. 9(5):725-9. [Medline].
Wilson RL, McGinty LD. Common hand and wrist injuries in basketball players. Clin Sports Med. 1993 Apr. 12(2):265-91. [Medline].
Franz T, von Wartburg U, Schibli-Beer S, Jung FJ, Jandali AR, Calcagni M, et al. Extra-articular fractures of the proximal phalanges of the fingers: a comparison of 2 methods of functional, conservative treatment. J Hand Surg Am. 2012 May. 37(5):889-98. [Medline].
Fok MW, Ip WY, Fung BK, Chan RK, Chow SP. Ten-year results using a dynamic treatment for proximal phalangeal fractures of the hands. Orthopedics. 2013 Mar. 36(3):e348-52. [Medline].
Klein DM, Belsole RJ. Percutaneous treatment of carpal, metacarpal, and phalangeal injuries. Clin Orthop Relat Res. 2000 Jun. 375:116-25. [Medline].
Onishi T, Omokawa S, Shimizu T, Fujitani R, Shigematsu K, Tanaka Y. Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures. Plast Reconstr Surg Glob Open. 2015 Jun. 3 (6):e431. [Medline].
Bowers AL, Baldwin KD, Sennett BJ. Athletic hand injuries in intercollegiate field hockey players. Med Sci Sports Exerc. 2008 Dec. 40(12):2022-6. [Medline].
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). 2008 Nov. 23(9):1136-40. [Medline].
Matzon JL, Cornwall R. A stepwise algorithm for surgical treatment of type II displaced pediatric phalangeal neck fractures. J Hand Surg Am. 2014 Mar. 39(3):467-73. [Medline].
Held M, Jordaan P, Laubscher M, Singer M, Solomons M. Conservative treatment of fractures of the proximal phalanx: an option even for unstable fracture patterns. Hand Surg. 2013. 18(2):229-34. [Medline].
Franz T, Jandali AR, Jung FJ, Leclère FM, von Wartburg U, Hug U. Functional-conservative treatment of extra-articular physeal fractures of the proximal phalanges in children and adolescents. Eur J Pediatr Surg. 2013 Aug. 23(4):317-21. [Medline].