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.

Treatment & Management

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Media Gallery

Acute dorsal proximal interphalangeal joint fracture-dislocation.

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Author

Jay E Bowen, DO Assistant Professor, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School

Jay E Bowen, DO is a member of the following medical societies: American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, North American Spine Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems<br/>Have a 5% or greater equity interest in: DataBiologics.

Coauthor(s)

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

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, American Institute of Ultrasound in Medicine, International Spine Intervention Society, North American Spine Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems.

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 Physician, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

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, 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

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Phalangeal Fractures Workup

Imaging Studies

Procedures

References

Tables

Contributor Information and Disclosures

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