summary Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Epidemiology Incidence most common injuries to the skeletal system accounts for 10% of all fractures Demographics more common in males 2:1 Location distal phalanx > middle phalanx > proximal phalanx small finger is most commonly affected (accounts for 38% of all hand fractures) Etiology Pathophysiology mechanism of injury depends on age login to view 3 more bullets Associated conditions nail bed injuries associated with distal phalanx fractures Anatomy Osteology distal phalanx 3 components login to view 3 more bullets middle and proximal phalanx 4 components login to view 4 more bullets displacement of middle phalanx fracture login to view 4 more bullets displacement of proximal phalanx fracture login to view 3 more bullets Arthrology interphalangeal joint hinge joint login to view 2 more bullets Ligaments collateral ligaments proper accessory Tendons terminal extensor tendon inserts on dorsal base of distal phalanx FDP inserts on volar base of distal phalanx central slip terminal slip of EDC inserts on dorsal aspect of middle phalanx FDS inserts on volar shaft of middle phalanx Blood Supply proper digital arteries dominant artery found on median side of phalanges (closer to midline) Nervous System proper digital nerves volar to proper digital arteries Biomechancis Classification Descriptive proximal phalanx location login to view 13 more bullets middle phalanx location login to view 36 more bullets distal phalanx Classification login to view 22 more bullets intra-articular vs extra-articular fracture morphology amount of displacement open vs closed Presentation History hand dominance baseline function occupation and hobbies mechanism of injury Physical Exam inspection swelling ecchymosis deformity (angular, rotation, shortening) open wounds motion assess for scissoring of digits login to view 2 more bullets neurovascular digital nerve login to view 1 more bullet vascular assessment login to view 1 more bullet Imaging Radiographs recommended views PA lateral oblique findings proximal phalanx login to view 3 more bullets middle phalanx login to view 2 more bullets CT scan indications assess articular involvement findings amount of articular displacement degree of comminution Differential Differential Diagnosis Stress fracture Jammed finger fracture-dislocation gout finger infection neoplasm Diagnosis Radiographs diagnosis confirmed by history, physical, and orthogonal radiographs Proximal Phalanx Fractures Nonoperative buddy taping vs. splinting indications login to view 2 more bullets technique login to view 1 more bullet Operative CRPP vs. ORIF indications login to view 4 more bullets techniques login to view 4 more bullets Middle Phalanx Fractures Nonoperative buddy taping vs. splinting indications login to view 2 more bullets technique login to view 1 more bullet Operative CRPP vs. ORIF indications login to view 3 more bullets techniques login to view 6 more bullets Distal Phalanx Fractures Nonoperative closed reduction +/- splinting indications login to view 1 more bullet nail matrix may be incarcerated in fracture and block reduction Operative remove nail, repair nailbed, and replace nail to maintain epi fold indications login to view 3 more bullets CRPP vs. ORIF indications login to view 4 more bullets techniques login to view 3 more bullets Complications Loss of motion most common complication risk factors prolonged immobilization intra-articular fracture extensive surgical dissection treatment aggressive hand therapy login to view 1 more bullet surgical release login to view 1 more bullet Malunion types malrotation angulation login to view 1 more bullet shortening treatment nonoperative login to view 1 more bullet surgery login to view 4 more bullets Nonunion uncommon (<2%) most atrophic and associated with bone loss or neurovascular compromise surgical options resection, bone grafting, plating ray amputation or fusion