Phalangeal Fracture

Overview

what it is and why it matters

Palmar dissection of the hand and wrist showing the eight carpal bones, flexor tendons, and median and ulnar nerves. — **Hand and wrist anatomy.** Eight small carpal bones form the wrist and connect the forearm to the five metacarpals of the palm. Finger tendons and the median and ulnar nerves pass through narrow tunnels in the wrist on their way into the hand.

Phalangeal fractures are extremely common and range from a stable non-displaced proximal phalanx fracture to a complex intra-articular pilon fracture of the middle or distal phalanx requiring surgical reconstruction. The most important factors in management are: rotation (always a surgical indication), articular involvement, and which phalanx is injured — proximal phalanx fractures are most likely to cause permanent stiffness if not managed carefully.

Diagnosis

exam first, imaging second

PA, lateral, and oblique finger X-rays. Rotational deformity is assessed clinically. CT is added for complex intra-articular injuries. Tendon integrity (FDP for mallet/jersey-finger, central slip for boutonnière) must be assessed clinically.

Treatment Path

how care progresses at OSI

Buddy taping

For non-displaced stable fractures — the adjacent finger acts as a dynamic splint.

Dorsal extension blocking splint

For volar plate avulsion fractures — blocks full extension while allowing flexion.

Surgical Options at OSI

if non-operative care isn't enough

Rotation, intra-articular step-off >1 mm at the PIP or DIP joint, and fractures unstable in splinting require fixation.

Primary procedure

Fracture ORIF (open reduction and internal fixation)

Surgical stabilization for displaced or unstable fractures.

Learn about this procedure →

Providers Who Treat Phalangeal Fracture

sports-medicine team

Overview

Diagnosis

Treatment Path

Buddy taping

Dorsal extension blocking splint

Surgical Options at OSI

Providers Who Treat Phalangeal Fracture

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Further Reading

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