Phalangeal fractures are common injuries that can involve one or more of the bones of the digits in the hand. Phalangeal fractures most commonly involve the distal phalanx and less commonly involve the proximal phalanx. Proximal phalanx fractures in the hand have a bimodal age distribution and are commonly seen in younger males with high-energy mechanisms or older females with lower-energy mechanisms in the setting of osteoporosis. Overall, the injury is more common in males and decreases in frequency with increasing socioeconomic status.

Causes / typical injury mechanism: The most common injury mechanism is trauma during sports. Work injury and ground-level fall are other mechanisms. Fractures typically result from forced rotation, hyperextension, or direct trauma, typically in the form of an axial load.

Classic history and presentation: Pain, swelling, alteration in range of motion, and potential deformity at the site of the fracture, all which vary with mechanism of injury. Occasionally, the deformity or the fracture itself might be obscured by swelling of the surrounding soft tissue.

Prevalence:

• Age – Those aged 18-49 years have phalangeal fractures as the most common upper extremity injury.
• Sex / gender – Males have a much larger predominance, at a frequency of 2:1.

Risk factors: Sports, low socioeconomic status, osteoporosis.

Pathophysiology: Force from trauma to the digit causing a fracture.

Grade / classification system: Can be classified by the location of where they occur (eg, shaft, neck, and articular base) as well as the morphology of the fracture (eg, transverse, long and short oblique, commuted, and spiral).

Proximal phalanx head fractures can be categorized as:

• Nondisplaced.
• Unstable unicondylar.
• Bicondylar or comminuted.

Shaft fractures are classified by morphology, including transverse, short / long oblique, and spiral.

The most common fracture types in the proximal phalanx are spiral and oblique. Fractures of the base can be classified as intra-articular and extra-articular.