How are phalangeal fractures graded?

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

  • Instability of the PIP joint is classified as 3 grades, and treatment is based on the grading of the injury. Grading is based on active range of motion and stress testing. When pain interferes with evaluating for these, a local anesthetic block at the metacarpal level should be performed.

    • Grade I injuries are stable through an active range of motion and do not angulate more than 20° greater than the contralateral side on stress testing.

    • Grade II injuries will not deform with active range of motion, but stress testing will show instability, defined as greater than 20° of angulation when compared with the contralateral side. These injuries are due to a complete disruption of one of the major retaining ligaments, which include the radial or ulnar collateral ligaments, the volar plate, or the central extensor slip.

    • Grade III injuries show deformity with active range of motion or the injured fingers are unable to be moved through more than 75% of the range of motion under anesthetic block. This implies complete disruption of greater than 50% of the entire capsule or 2 or more of the major retaining ligaments.

  • Collateral ligament injuries may be the result of a pure angulatory stress or a joint dislocation with the radial collateral ligament as the ligament most frequently injured.

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