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Middle phalanx fracture

Case contributed by Francis Deng
Diagnosis certain

Presentation

Fall onto hand while snowboarding three weeks ago. The index finger is stiff and tender around the mid digit but without angular deformity.

Patient Data

Age: 40 years
Gender: Female

3 weeks after injury

x-ray

There are linear lucencies at the index (second) finger middle phalanx base, both at the ulnar and radial aspects, and irregularity of the articular surface, concerning for minimally displaced intraarticular fractures. Mild soft tissue swelling is noted about the proximal interphalangeal joint.

Annotated image

Zoomed in, the frontal and lateral projections demonstrate the subtle findings of a nondisplaced oblique intraarticular fracture through the ulnar base of the index finger middle phalanx (blue arrow) and a depression fracture of the radial and volar aspect of the index finger middle phalanx base (red arrow).

5 weeks after injury

ct

Redemonstrated findings of (1) minimally displaced intraarticular fracture of the ulnar base of the index finger middle phalanx, and separately (2) a 1 mm articular surface depression of the radial aspect of the same bone. There is soft tissue swelling around the index finger proximal interphalangeal joint but no evidence of subluxation or dislocation.

Case Discussion

Nondisplaced/minimally displaced fractures may be difficult to detect. History and physical examination findings, if available, and soft tissue swelling should guide the reader to the location of injury. The findings of middle phalanx fracture were reported on the radiographs but CT was requested in this case to better visualize the fracture pattern. Given that there was no significant displacement or dislocation, the fracture was managed nonoperatively.

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