Hand Case 6 History/Physical Exam

Proximal phalanx fracture

The mechanism of the injury often determines the nature of the fracture; a direct blow will lead to a comminuted or transverse deformity whereas a twisting injury will result in an oblique or spiral fracture (as in this case).

Be sure to check for rotational deformities, which may be more easily diagnosed by physical exam than radiographically. These may not be apparent until the patient flexes all the digits simultaneously. When flexed simultaneously, each finger should point toward the scaphoid. If the injured finger points in a different direction than the others when flexed, a rotational deformity is present. Also assess for nerve and tendon injuries.