February 21, 2011 by dailybolusoflr
Fractures of the distal phalynx are the most common fractures of the hand.
· They are most commonly as a result of a crush injury.
· Given this mechanism, associated injuries to the tissue, nail and nail bed are common.
· The most common location of a distal phalygeal fracture is at the tuft or most distal part.
Proximal phalyngeal fractures are grouped with fractures of the middle phalynx.
· The proximal phalynx has no tendinous insertions.
· The middle phalynx has two insertions: the tendons of the flexor digitorum superficialis divides and insert on the volar surface of the bone.
Given the insertion point of the flexor digitorum profundus (FDP) on the distal phalynx (as well as the flexor digitorum superficialis (FDS) on the middle phalynx), tendon injuries must be assessed whenever there is an injury any of the phalynges.
Testing for the FDP involves: Hold the MCP and PIP of the finger being tested in extension. Ask the patient to flex the finger at the DIP joint.
Testing for the FDS involves: Hold all of the fingers in extension except for the finger being tested. Ask for patient to flex the finger at the PIP joint.
· The most common complication of phalygeal fractures is malunion.
· This may result in malrotation, angulation or shortening
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions