Proximal Phalanx Fracture

Aka: Proximal Phalanx Fracture

1. See Also
   1. Phalanx Fracture
   2. Fifth Proximal Phalanx Epiphyseal Fracture
   3. Metacarpal-Phalangeal Dislocation
2. Mechanism
   1. Direct blow or axial load injury
3. Precautions
   1. Proximal Phalanx Fractures are often unstable
      1. Interosseous Muscles pull the proximal Fracture into flexion
      2. Extensor Muscles pull the distal Fracture into extension
4. Signs
   1. Volar angulation of Fracture site
   2. Rotational deformity if oblique Fracture
   3. Local swelling, Bruising and tenderness overlying Fracture
   4. Evaluate for malrotation (overlap deformity of affected finger when flexing fingers into a fist)
      1. Axes of all flexed fingers should point toward Scaphoid Bone or radial styloid (thenar eminence)
      2. 
5. Imaging: XRay of Digit (AP, Lateral, Oblique)
   1. Evaluate for intraarticular, oblique, spliral or rotational Fractures (require orthopedic referral)
   2. Perform before and after manual reduction
6. Management
   1. See Phalanx Fracture
   2. Reduction of transverse Fracture
      1. Apply traction away from tubercle of Scaphoid
      2. Flexion applied to distal fragment
   3. Immobilization for 4 weeks
      1. Splint in position of moderate flexion with ulnar gutter or radial gutter
   4. Open Reduction and Internal Fixation (ORIF) Indications
      1. Open Fracture
      2. Unstable Fractures (e.g. oblique, spiral, comminuted, rotational or intraarticular)
      3. Transverse Fracture with >2 mm displacement
      4. Angulation or malrotation >10 degrees
7. References
   1. Perkins (2020) Crit Dec Emerg Med 34(10): 10-1