Phalangeal Fracture Surgery Clinical Presentation

Updated: Sep 28, 2015
  • Author: Brian J Divelbiss, MD; Chief Editor: Harris Gellman, MD  more...
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Presentation

History and Physical Examination

The clinical presentation of finger fractures and dislocations depends primarily on the mechanism of injury. Crushing injuries to the fingertip commonly involve the nail bed in addition to the underlying distal phalanx. Injuries at the interphalangeal joints usually manifest with swelling, ecchymosis, and decreased motion. Deformity may also be present at the joint, as well as in the diaphysis of a displaced unstable fracture. [3]

Transverse fractures in the proximal phalanx assume an apex volar deformity secondary to pulling of the intrinsic tendons on the proximal fragment and of the extensor tendon on the middle phalanx. Fractures of the middle phalanx may angulate in an apex dorsal or volar fashion, depending on whether the fracture occurs proximal or distal to the sublimis insertion, respectively. Care must be taken to evaluate the digit for rotational deformity as well. This is best accomplished by flexing the fingers and viewing the nails on end. Comparison with the contralateral hand is essential.