Phalangeal Injuries, Hand

Basics

Description

  • 1/3 of all traumatic injuries affect the hand
  • Phalanges account for one of the most frequently fractured parts of the skeletal system with the distal phalanx being the most commonly fractured bone in the hand
  • Dorsal displacement of the proximal interphalangeal joint of the finger is the most frequent dislocation

Pediatric Considerations

  • Disability from hand injuries can have life-changing implications based on a patient’s age, vocation, and hobbies
  • Injuries may be more difficult to diagnose in children who are unable to cooperate for a full exam

Etiology

  • Trauma (commonly work or sports related)
  • Infectious sequelae:
    • Felon
    • Paronychia
    • Flexor tenosynovitis
    • Subungual abscess
    • Osteomyelitis
  • Causative pathogens:
    • Skin flora: Staphylococcus aureus and Streptococci
    • Cat/dog bites: S. aureus and Pasteurella multocida
    • Human bites: Eikenella
    • Thorns or woody plants puncture: Fungal
    • Fresh-/salt-water exposure: Mycobacterium marinum and Pseudomonas aeruginosa
  • Inflammatory (eg, gout, RA, osteoarthritis)
  • Overuse injury (eg, “gamekeeper’s thumb”)

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