Phalangeal Fractures Workup

Updated: Jan 18, 2018
  • Author: Jay E Bowen, DO; Chief Editor: Craig C Young, MD  more...
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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.

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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.

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