Which medical history is characteristic of distal phalangeal fractures?

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

Distal phalangeal fractures

  • Most distal phalangeal fractures are crush injuries from a perpendicular force, as in injuries from a car door or hammer or in sports when a player has a digit stepped on or crushed between the helmets of opposing players. Tuft fractures are often comminuted and are generally stable fractures because of intrinsic splinting of bony fragments by fibrous septae in the fingertips.

  • Physical examination in a person suspected of having a phalangeal fracture starts with inspection, attitude of the injured finger, and localization of any swelling. Neurovascular status should be examined as well as color, capillary refill, and digital temperature.

    • Palpation of the joint over 4 planes (ie, dorsal, volar, medial, lateral) allows assessment of point tenderness over ligamentous origins and insertions, which is suggestive of soft-tissue disruption.

    • Passive range of motion and joint stability should be assessed through dorsal, volar, and lateral stressing. It should not be assumed that lack of full active flexion or extension is merely secondary to joint pain.

  • Fractures at the base of the distal phalanx are usually mallet avulsion fractures and are caused by rupture of the extensor tendon at the DIP joint. These are common injuries in basketball or baseball players. [7] The mechanism of injury usually results from a direct blow to the tip of the finger that causes forced flexion of the DIP joint.


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