Fractures of the distal phalanx are the most common fractures in the hand.
In comminuted crush injuries, treatment of the fracture is of secondary importance. More important is soft-tissue management, i.e. of the pulp and of the nail matrix.
Multifragmentary fractures of the distal phalanx will often heal without complications due to the intrinsic stability provided by the soft tissues. The nail matrix, lateral interosseous ligaments and the fibrous septa are the main stabilizing structures. Therefore, simple splinting often provides adequate stability after soft-tissue repair.
Unstable, or displaced, fractures should be fixed internally with 1 or 2 K-wires, in order to prevent subsequent malunion, nonunion, or other complications such as nail deformity. A nail plate base, if avulsed, should be replaced deep to the eponychium – this helps to hold the fracture in reduction.
|Stable, undisplaced, and closed fracture|
- Open fractures
|Unstable, comminuted, or open fractures|
- Grossly contaminated injuries
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|