Epidemiology and Fracture Patterns of Traumatic Phalangeal Fractures

Abstract

Background: Despite the relatively high incidence of phalangeal fractures, there is an imperfect understanding of the epidemiology and anatomical distribution of these fractures. This study describes the patient characteristics, anatomic distribution, and detailed fracture patterns of phalangeal fractures among a large adult cohort in the United States. Methods: A retrospective study was performed among patients with phalangeal fractures in the United States between January 2010 and January 2015. Included patients were 18 years old or older and had a diagnosis of a phalangeal fracture. A total of 2140 phalangeal fractures in 1747 patients were included, and a manual chart review was performed to collect epidemiological and radiographic information. Fractures were classified based on location and fracture pattern. Results: The median age at the time of injury was 45 years (interquartile range, 30–57), and 65% of patients were men. The small finger had the highest incidence of fractures (26%) followed by the ring finger (24%). Distal and proximal phalanges demonstrated the highest incidence of fractures at 39% each. The dominant hand was affected in 44% of cases. Eighteen percent of fractures were due to a work-related trauma mechanism, and the most common mechanism of injury was blunt trauma (46%). Conclusion: This study provides a detailed overview of the anatomic distribution and fracture patterns of phalangeal fractures in an adult US population and, thus, may aid hand surgeons treating these injuries.

Fractures of the phalanges

“…Phalangeal fractures may occur at any age; however, the majority occur in men in the fourth decade of life (Moura et al., 2022). Risk factors include behavioural decisions, occupational hazards and participation in sport.…”

“…Previous publications disagree regarding the specific details of phalangeal fractures. The little finger has been described as the most vulnerable to fracture due to its unprotected outer location (Moura et al., 2022). Conversely, others say the length of the middle finger predispose it to a higher proportion of phalangeal fractures (Brown, 1967).…”

“…The most common phalanx to be fractured also varied across the literature. Moura et al. (2022) and Kremer et al.…”

“…As force is transmitted proximally, the narrow diameter of the phalangeal shaft is unable to withstand additional load and yields. Moura et al. (2022) reported a transverse fracture of the shaft of the phalanx to be the most common fracture pattern and location.…”

“…The most common phalanx to be fractured also varied across the literature. Moura et al (2022) and Kremer et al (2022) reported the distal phalanx had the highest incidence of fracture across the index, middle and ring fingers, and the proximal phalanx had the highest incidence of fracture in the little finger. Van Oosterom et al (2001) reported the proximal phalanx had the highest incidence of fracture for the index, middle and little fingers.…”