Distal Phalanx Fracture
Classification / Treatment

• Non-displaced: splint (alumifoam or Stack splints) Active ROM at the DIP joint can be allowed since tendon insertions are intact.
• Displaced: CRPP

Lateral view of Distal Phalanx

1. Terminal Extensor tendon
2. Middle Phalangeal Head
3. FDP tendon
4. Dorsal base
5. Volar base
6. Shaft
7. Tuft (head)

Dorsal Base Distal Phalanx Fracture

• Can be shearing fractures (usually >20% of articular surface) or avulsion fractures (Mallet finger)
• Non-displaced: splint (alumifoam or Stack splints) with DIP jont immobilized.
• Displaced: Extension block pinning. (Pegoli L, J Hand Surg 2003;28B:15).

Lateral view of Distal Phalanx

1. Terminal extensor tendon
2. Middle Phalangeal Head
3. FDP tendon
4. Dorsal base
5. Volar base
6. Shaft
7. Tuft (head)

• Can be shearing fractures (usually >20% of articular surface) or FDP avulsion fractures (Type III Jersey Finger).
• Non-displaced: (rare) splint (alumifoam or Stack splints) with DIP jont immobilized.
• Displaced: ORIF. Large fragment fixation via suture of mini-fragment screws as indicated. See Jersey Finger for technique.

Lateral view of Distal Phalanx

1. Extensor tendon
2. Middle Phalangeal Head
3. FDP tendon
4. Dorsal base
5. Volar base
6. Shaft
7. Tuft (head)

• Non-displaced: splint (alumifoam or Stack splints)
• Displaced (dorsal surface of the phalanx displaced): CRPP focused on providing a level dorsal surface to support the nail bed.
• commonly associated with nail bed injuries which should be treated concomitantly.

A/P view of Distal Phalanx

1. Tuft (head)
2. Shaft
3. Base
4. Middle phalangeal base

• Non-displaced: splint (alumifoam or Stack splints)
• Displaced: CRPP with two transverse 0.028-in or 0.035-in K-wires.

A/P view of Distal Phalanx

1. Tuft (head)
2. Shaft
3. Base
4. Middle phalangeal base

• Non-displaced: rare, tendon forces usually displace fragments. splint (alumifoam or Stack splints)
• Displaced: typically severe injuries. Treatment is dependent on the associated soft-tissue injury. Varying combinations of the techniques desribed for volar base and dorsal base fractures should be employed.

Lateral view of Distal Phalanx

1. Terminal Extensor tendon
2. Middle Phalangeal Head
3. FDP tendon
4. Dorsal base
5. Volar base
6. Shaft
7. Tuft (head)