Synopsis

• Can occur at any age, although 70% of cases occur between the ages of 11 and 45 years.
• 58% male predominance.
• Phalanx fractures account for 10% of all fractures.
• Border digits are most commonly affected.
• The distal phalanx is the most commonly injured phalanx.

• Fractures can include the tuft (tip), shaft, or articular surface.
• Tuft fractures are often associated with surrounding soft tissue injuries and should be considered open with associated nail bed injury (see Seymour fracture).
• Shaft fractures may have transverse or longitudinal orientation.
• Intraarticular fractures may result in tendon avulsion:
• Mallet finger – Avulsion of the terminal extensor tendon from the dorsal lip of the distal phalanx.
• Jersey finger – Avulsion of the flexor digitorum profundus from the volar lip of the distal phalanx.

• Divided into phalangeal head, neck, shaft, base, and pilon fractures.
• Angulation is determined by fracture location in relationship to the flexor digitorum superficialis (FDS) and central slip of the extensor tendon insertions.

• As with the middle phalanx, divided into phalangeal head, neck, shaft, base, and pilon fractures.
• Typically result in apex volar angulation based on proximal fragment flexion from interossei pull and distal fragment extension from central slip forces.

• Type I: Through the physis only
• Type II: Through the metaphysis and physis
• Type III: Through the epiphysis and physis
• Type IV: Through the epiphysis, physis, and metaphysis
• Type V: Crush injury to the physis

• Class I: Stable fracture without displacement
• Class II: Unicondylar, unstable fracture
• Class III: Bicondylar, comminuted fracture