Fractures of hand phalanges

Specifics of injuries and classification

Injuries to the bones of the hand are quite common. Despite the fact that blood supply in this area is generally considered good (except for specific zones, such as the scaphoid neck), the treatment of such fractures is associated with a number of difficulties.

The specific anatomical structure and high functional requirements dictate the need to treat patients in specialized hand surgery departments. This requires not only the participation of specially trained medical personnel, but also the availability of appropriate equipment.

For practical convenience, the most common injuries are divided by localization into three main groups:

1. Carpal bone fractures.
2. Metacarpal bone fractures.
3. Phalangeal fractures.

Anatomical and biomechanical features of the phalanges

Normal hand biomechanics are oriented toward ensuring two main functions of the fingers—grip and opposition. In a healthy hand, there is a clear geometric pattern: during flexion of digits II through V, the extensions of their axes invariably intersect at a single point. This point is located at the border between the lunate (os lunatum) and scaphoid bones of the wrist.

In fractures of the phalanx diaphysis, secondary displacement of bone fragments often occurs. It is caused by the traction of muscles attached here, which leads to the formation of typical deformations. Any unreduced displacement has a catastrophic effect on hand function.

Pathological biomechanics in displacements

If the anatomy of the broken phalanx is not perfectly restored, pathological biomechanics develop:

• Rotational displacement: Most commonly occurs in fractures of the proximal and middle phalanges. The rotation of the fragment around its axis disrupts the normal intersection of the finger axes. During flexion, the fingers begin to cross over each other, making normal grip impossible and impairing basic hand functions.
• Dorsal displacement: A characteristic type of deformity specifically for fractures of the finger phalanges. The dorsal displacement of the fragments becomes a serious mechanical obstacle that sharply limits or completely impairs the flexion function of the injured finger.

This is why a strict postulate applies in hand surgery: hand function will be preserved only under the condition of complete anatomical restoration of the damaged phalanx.

Pre-hospital care and routing

Correct actions at the first-aid stage largely determine the success of subsequent treatment. The basic algorithm includes two mandatory steps:

1. Pain management. It is necessary to administer analgesics to the patient to relieve the pain syndrome.
2. Immobilization. Performed using a wire ladder splint (Kramer splint) or available improvised means. It is important to observe the correct boundaries of fixation: the splint must capture the area from the upper third of the forearm all the way to the fingertips.

After emergency care is provided, further tactics (choosing between inpatient or outpatient treatment), as well as definitive diagnosis, must be carried out exclusively by a specialized expert who thoroughly understands all the nuances of hand injuries.

Briefly: answers to topical questions

What else to study on this topic

• Features of metacarpal diaphysis fractures
• Intra-articular fractures of the base of the first metacarpal bone
• Blood supply to the scaphoid bone and risks of avascular necrosis
• Principles of conservative and surgical treatment of scaphoid fractures
• Disruption of the metacarpal head arc in unreduced displacement

Other topics in the "Specialized Adult Traumatology" section

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