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Proximal & Middle Phalanx Fracture

  • Proximal Phalanx fracture most common hand fracture.

  • Majority are SH I or SH II

  • Most managed non operatively

  • Phalageal neck fractures are more problematic and have limited remodelling potential.

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REFER to PLASTICS if:

  • Open fracture

  • All intraarticular injuries

  • All growth plate injuries

  • Phalangeal neck fractures

  • Other associated fractures in same hand.

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MANAGEMENT

  • Analgesia

  • Closed reduction and buddy strap.

    • Proximal Phalanx shaft fracture -10 degree angulation is acceptable.​

  • Simple minimally displaced shaft fractures can be followed up in Fracture clinic

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PHALANGEAL NECK FRACTURE

  • Often missed on xray

  • usually due to finger being caught in closing door or swing.

  • The distal “cap” of the proximal phalanx is not yet ossified in childhood, making these injuries difficult to detect on X-ray

  • Proximal fragment blocks flexion

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