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THUMB DISTAL PHALANX FRACTURE

Introduction

Fracture Nomenclature for Thumb Distal Phalanx Fracture

Hand Surgery Resource’s Diagnostic Guides describe fractures by the anatomical name of the fractured bone and then characterize the fracture by the Acronym:

In addition, anatomically named fractures are often also identified by specific eponyms or other special features.

For the Thumb Distal Phalanx Fracture, the historical and specifically named fractures include:

Mallet thumb fracture

IP joint fracture-dislocation

By selecting the name (diagnosis), you will be linked to the introduction section of this Diagnostic Guide dedicated to the selected fracture eponym.

Fractures of the distal phalanx are the most common fractures that occur in the hand, and the thumb is the second most frequently affected digit of these fractures behind the long finger. Thumb distal phalanx fractures are particularly prevalent in sports and work-related accidents, with trauma and crushing forces being the most typical mechanisms of injury.1-4

Definitions

  • A thumb distal phalanx fracture is a disruption of the mechanical integrity of the most distal bone of the thumb underlying the nail.
  • A thumb distal phalanx fracture produces a discontinuity in the distal phalanx contours that can be complete or incomplete.
  • A thumb distal phalanx fracture is caused by a direct force that exceeds the breaking point of the bone.  

Hand Surgery Resource’s Fracture Description and Characterization Acronym

SPORADIC

S – Stability; P – Pattern; O – Open; R – Rotation; A – Angulation; D – Displacement; I – Intra-articular; C – Closed

S - Stability (stable or unstable)

  • Universally accepted definitions of clinical fracture stability is not well defined in the hand surgery literature.5-7
  • Stable: fracture fragment pattern is generally nondisplaced or minimally displaced. It does not require reduction, and the fracture fragments’ alignment is maintained with simple splinting. However, most definitions define a stable fracture as one that will maintain anatomical alignment after a simple closed reduction and splinting. Some authors add that stable fractures remain aligned, even when adjacent joints are put to a partial range of motion (ROM).
  • Unstable: fracture fragments will not remain anatomically or nearly anatomically aligned after a successful closed reduction and simple splinting. Typically unstable thumb distal phalanx fractures have significant deformity with comminution, displacement, angulation, and/or shortening.

P - Pattern

  • Thumb distal phalanx tuft: oblique, transverse, or comminuted; tuft fractures usually result from crush injuries, and they are often comminuted and nearly always associated with an injury to the nailbed matrix, digit pulp, or both.1,8
  • Thumb distal phalanx shaft: transverse, oblique, or comminuted with or without shortening; transverse shaft fractures are potentially unstable, as the fracture angulates with its apex anterior secondary to the pull of the flexor pollicis longus (FPL) tendon on the proximal fragment.1
  • Thumb distal phalanx base: can involve the interphalangeal (IP) joint; these intra-articular fractures usually involve the dorsal or volar lip of the thumb distal phalanx base.

O - Open

  • Open: a wound connects the external environment to the fracture site. The wound provides a pathway for bacteria to reach and infect the fracture site. As a result, there is always a risk in developing osteomyelitis. Therefore, open fractures of the thumb distal phalanx require antibiotics with surgical irrigation and wound debridement.5,9,10

R - Rotation

  • Thumb distal phalanx fracture deformity can be caused by proximal rotation of the fracture fragment in relation to the distal fracture fragment.
  • Degree of malrotation of the fracture fragments can be used to describe the fracture deformity; this is not a common type of fracture deformity in the thumb distal phalanx.

A - Angulation (fracture fragments in relationship to one another)

  • Angulation is measured in degrees after identifying the direction of the apex of the angulation.
  • Straight: no angulatory deformity
  • Angulated: bent at the fracture site
  • Example: thumb distal phalanx fractures with >20-30° of angulation in the sagittal plane can result in extensor lag of the IP joint1

D - Displacement (Contour)

  • Displaced: disrupted cortical contours (eg, thumb distal phalanx shaft fractures can be displaced or translated partially or completely)
  • Nondisplaced: fracture line defining one or several fracture fragments; however, the external cortical contours are not significantly disrupted

I - Intra-articular involvement

  • Fractures that enter a joint with one or more of their fracture lines. Intra-articular fractures of the thumb distal phalanx require special attention due to the digit’s indispensible role in hand function.10
  • Thumb distal phalanx fractures can have fragment involvement with the IP joint.
  • If a fracture line enters a joint but does not displace the articular surface of the joint, then the risk of developing post traumatic osteoarthritis is relatively low. If the articular surface is separated or there is a step-off in the articular surface then the congruity of the joint will be compromised and the risk of posttraumatic osteoarthritis increases significantly.

C - Closed

  • Closed: no associated wounds; the external environment has no connection to the fracture site or any of the fracture fragments.5-7

Thumb distal phalanx fractures: named fractures, fractures with eponyms and other special fractures

Mallet thumb fracture

  • An avulsion fracture of the extensor pollicis longus (EPL) tendon from its distal phalangeal insertion at the dorsal base of the bone is commonly referred to as mallet thumb.1,11
    • Results from a flexion force directed to an actively extended thumb, which hyperflexes the IP joint and produces either stretching or tearing of the extensor tendon substance or an avulsion of the tendon from its insertion on the distal phalanx.12
    • Most occur in a work environment or during sports participation.8,12
  • Mallet thumb is far less common than mallet finger, accounting for ~2-3% of all mallet injuries. Thus, less is known about mallet thumb.13
  • In one study, individuals with mallet thumb had a smaller percentage of fragment displacement and articular involvement, as well as no subluxation, compared to those with mallet finger injuries. This may be due to greater extensor strength of the EPL compared with the terminal extensor tendon, differences in the tendon attachments, and tighter capsule that together make the IP joint more stable and limit subluxation.
    • Patients also presented earlier than those with mallet finger, which may be due to the relative importance of the thumb to hand function and the fact that the extensor lag is more noticeable because the IP joint can hyperextend.11

Imaging

  • Posteroanterior, oblique, and lateral radiograph views are recommended - The thumb can be a difficult bone  to image. A Robert's view with hyperpronation of the extermity helps obtain an anteroposterior xray.
  • Radiographs should be obtained before active motion testing to prevent potential displacement of an avulsed fracture fragment.
  • MRI may also be useful for identifying mallet thumb injuries.

Treatment

  • Due to the low incidence of mallet thumb, there is a lack of consensus on the optimal management strategy to address these injuries, and the role of surgery is not completely clear.11,14
  • Treatment for both open and closed mallet thumb injuries varies from splinting of the IP joint alone to operative repair with or without temporary K-wire fixation of the IP joint.
    • The prevailing opinion of most authors is to treat closed mallet thumb injuries nonsurgically with splinting—although there is still ongoing debate regarding this and the preferred type of splint is unclear—and to treat open injuries with primary tendon repair.12,14
    • Conservative treatment is also indicated for fragments <30-40% of the joint surface or those with displacement of <2 mm.
  • When surgery is indicated, the tendon is repaired after the IP joint is pinned in hyperextension. The K-wire is removed at 6 weeks postoperatively, and a splint is to be worn for the next 6 weeks, followed by nighttime splinting for another 4 weeks.14
    • Cases in which the proximal severed EPL tendon retracts proximal to the IP joint may also necessitate surgery at the time of presentation, since a conservative approach to management could ultimately fail.12
    • Other recommendations push for continuous extension splinting of the IP joint for 6 weeks unless there is volar subluxation of the distal phalanx.1

Complications

  • Infection
  • Posttraumatic osteoarthritis

Outcomes

  • Data comparing operative and conservative approaches for mallet thumb injuries is also lacking, and although the literature demonstrates that most authors advocate for a conservative approach for closed injuries followed by splinting for 6-8 weeks, operative management in these cases is still advocated by some.12
  • One study reported satisfactory results in 84% of mallet thumb patients treated with extension splinting, but noted that better outcomes occurred in those treated within 2 weeks of the injury, suggesting that early treatment may lead to superior outcomes. 8
  • One trial suggested that the greater the gap between the severed tendons in mallet thumb injuries, the less likely conservative treatment will be at attaining a good outcome, especially if the severed end heals by approximating proximal to the IP joint.12
  • Another study found that outcomes were similar between patients treated conservatively and surgically for mallet thumb injuries, with the only significant difference being immobilization time, which was 9.5 weeks in conservative patients compared to 4.9 weeks for surgical patients.15

IP joint fracture-dislocation

  • Dislocations and fracture-dislocations of the IP joint are uncommon injuries owing to the joint’s inherent stability. These injuries usually occur after an axial load is applied to the thumb, causing the distal phalanx to be dorsally displaced and radially rotated.16-18
  • A fracture-dislocation of the IP joint may also result in an avulsion fracture of the joint’s volar plate or the FPL tendon. A collateral ligament tear also can result from a volar plate avulsion.16
  • The volar plate of the IP joint inserts on the volar base of the distal phalanx just proximal to the fan-like insertion of the FPL tendon. Sesamoid bones may be present in the volar plate just proximal to its thinner midline portion. Centrally, the thumb’s IP volar plate also becomes thinner and is loosely anchored to the periosteum of the proximal phalanx.17

Imaging

  • Plain radiographs are usually sufficient, but an MRI may also be needed.

Treatment

  • The treatment of IP joint fracture-dislocations is dependent on the size and degree of comminution of the intra-articular fragments.
    • For small intra-articular fragments involving <25-40% of the articular surface, stable closed reduction is usually possible.
    • For a single, large non-comminuted fragment, ORIF may be possible. If the large intra-articular fragment is comminuted, internal fixation may not be technically feasible. In this case, the treatment options are less clear.
  • One option would involve temporary pinning in a reduced position followed by early motion.
  • Other options include mobile or immobile external fixation devices. Primary arthrodesis could be considered as a last resort.17
    • Surgical intervention may also be necessary if the patient fails closed reduction. Whether to perform temporary transarticular pinning should be determined by evaluating the stability by passive ROM and joint stability during the operation.16,18
  • If the volar plate or FPL has entered the joint space, it may need to be surgically repaired or extricated.18
    • Due to the anatomic similarity between the volar plates of the IP and PIP joints, a technique called Eaton volar plate arthroplasty may be appropriate for IP fracture-dislocations with volar plate avulsions.17

Complications

  • Infection
  • IP joint pain
  • IP joint stiffness and flexion contractures

Outcomes

  • Closed reduction of the IP joint has been found to be successful, especially with closed injuries. The most common reason for a failed reduction is avulsion of the volar plate with interposition into the IP joint.18

Related Anatomy

  • The thumb distal phalanx consists of a distal bony tuft, a narrow diaphyseal shaft, a proximal metaphysis, and a base that articulates at the IP joint with the proximal phalanx. The base of the thumb distal phalanx has a dorsal and volar lip.
  • Ligaments that attach to the thumb distal phalanx include the volar plate of the IP joint, the radial collateral ligament of the IP joint and the ulnar collateral ligament of the IP joint.
  • Tendon attachments include the FPL tendon and the EPL tendon, which inserts at the dorsal tubercle of the distal phalanx base. Unlike the extensor digitorum communis, the EPL lacks any “true” lateral bands, and instead, fibers from the abductor pollicis brevis and adductor pollicis insert on the radial and ulnar sides of the tendon, respectively.12
  • The thumb distal phalanx is further stabilized by fibrous septae in the pulp of the thumb and ulnar and radial lateral interosseous ligaments between the base and tuft of the thumb distal phalanx.

Incidence and Related injuries/conditions

  • Metacarpal and phalangeal fractures account for nearly half of all hand injuries that present to the emergency room.19
  • The most commonly fractured bone in the human hand is the distal phalanx.1,3
  • The highest number of distal phalanx fractures occur in the long finger, followed by the thumb.4
  • Fractures of the thumb are most common in the children and the elderly, with the thumb being the most commonly fractured tubular bone in elderly patients.20
    • Thumb distal phalanx fractures most commonly occur secondary to sports in younger patients, secondary to labor in middle-aged patients, and secondary to falls and motor vehicle accidents in older individuals.10
  • Mallet thumb injuries account for about 2-3% of all mallet finger injuries.13
  • Subungual hematomas are a common related injury.
ICD-10 Codes

  • MALLET THUMB FRACTURE

    Diagnostic Guide Name

    MALLET THUMB FRACTURE

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    MALLET THUMB FRACTURE    
    - DISPLACED S62.522_S62.521_ 
    - NONDISPLACED S62.525_S62.524_ 

    Instructions (ICD 10 CM 2020, U.S. Version)

    THE APPROPRIATE SEVENTH CHARACTER IS TO BE ADDED TO EACH CODE FROM CATEGORY S62
     Closed FracturesOpen Type I or II or OtherOpen Type IIIA, IIIB, or IIIC
    Initial EncounterABC
    Subsequent Routine HealingDEF
    Subsequent Delayed HealingGHJ
    Subsequent NonunionKMN
    Subsequent MalunionPQR
    SequelaSSS

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
  • Thumb distal phalanx non-displaced tuft fracture
    Thumb distal phalanx non-displaced tuft fracture
  • Thumb distal phalanx non-displaced shaft fracture
    Thumb distal phalanx non-displaced shaft fracture
  • Thumb distal phalanx displaced intra-articular EPL avulsion fracture
    Thumb distal phalanx displaced intra-articular EPL avulsion fracture
Symptoms
Pain in the injured thumb
Swelling in the injured thumb
Ecchymosis in the injured thumb
Deformity in the injured thumb
Loss of range of motion
Typical History

A classic patient with a thumb distal phalanx fracture is a 38-year-old, left-handed female who was speaking with a friend while holding onto the edge of a doorframe. Unexpectedly, the stopper holding the door was knocked loose, and the heavy metal door slammed shut directly on the woman’s left thumb. This crushing force fractured the tuft of her thumb’s distal phalanx, resulting in immediate pain and subsequent stiffness, swelling, and a subungual hematoma. If the latter is present, it likely represents injury to the nail bed as well.

Positive Tests, Exams or Signs
Work-up Options
Images (X-Ray, MRI, etc.)
Thumb Distal Phalanx Fracture X-rays
  • Small thumb distal phalanx tuft fracture (arrow)
    Small thumb distal phalanx tuft fracture (arrow)
Treatment Options
Treatment Goals
  • When treating closed thumb distal phalanx fractures, the treating surgeon has 4 basic goals:5,10
    1. A thumb with a normal appearance. The X-ray may not need to be perfect but the thumb should have no obvious deformity (ie, the thumb looks normal!)
    2. Avoid thumb stiffness by maintaining a normal functional ROM (ie, the thumb works!)
    3. The thumb is not painful (ie, the thumb does not hurt!)
    4. Congruent joint surface with none-to-minimal joint surface irregularities (ie, the joint does not develop early post-traumatic arthritis!)
    5. Fracture care should minimize the risk for infection and osteomyelitis (This is an additional goal outside of the four basic goals, but it is mandatory for open fractures)
  • Many thumb fractures are treated similarly to finger fractures, but special considering is needed since the thumb is distinct from the other digits: Whereas adjacent fingers can compensate for one another, there is no surrogate for the thumb. Therefore, intra-articular fractures of the thumb distal phalanx demand special care.10
Conservative
  • Most thumb distal phalanx fractures can be treated without surgical treatment.10
  • The typical closed, nondisplaced, minimally angulated, thumb distal phalanx fracture without significant malrotation can be managed in an aluminum plaster or fiberglass or custom splint.
    • Safe splinting of the thumb holds all joints in extension and the thumb in abduction.10
  • Thumb distal phalanx fractures usually do not require that the thumb be included in a short-arm cast.
  • Even thumb distal fractures that require a reduction to correct fracture-related deformity usually can be held in anatomic or near-anatomic alignment with a splint without internal or external surgical fixation.
  • Other indications for determining whether conservative or surgical treatment is appropriate include the following:
    • Fractures involving less than 30% of the joint are typically stable and can be treated with extension splinting.
    • Fractures with persistent volar subluxation, joint incongruity, or greater than 50% joint involvement should be addressed surgically.8
  • Because thumb distal phalanx tuft fractures are usually comminuted and nearly always associated with an injury to the nail matrix or pulp, or both, these injuries rarely require reduction or fixation. Instead, treatment should consist of evacuation of the painful subungual hematoma and repair of dermal and nail matrix lacerations when indicated. Splint immobilization is used for 3-4 weeks.1,8
  • Most crush injuries that result in a thumb distal phalanx fracture without articular involvement or major dislocation can be successfully treated conservatively with immobilization for several weeks.21
Operative
  • Surgical treatment of thumb distal phalanx fractures must always be an individualized therapeutic decision. However, surgical thumb distal phalanx fracture care is most frequently recommended when:
    1. Closed reduction fails or the simple splint or cast immobilization does not maintain the reduction. For these irreducible or unstable fractures, operative treatment is recommended to achieve the 4 treatment goals of fracture care.
    2. There is a significantly displaced base of thumb distal phalanx fracture involving the IP joint; surgical fracture care may be required (eg, displaced mallet thumb injuries and avulsion fractures of the volar plate and/or FPL of the IP joint).
    3. Open thumb distal phalanx fractures require surgical care in the form of irrigation and debridement to prevent chronic infection.
  • Percutaneous fixation is usually appropriate for most thumb distal phalanx fractures, and simple fractures rarely require ORIF.10
    • Thumb distal phalanx nonunions may also be surgically managed with percutaneous compression screws.10
    • Displaced spiral or oblique fractures may be treated by percutaneous pinning or by open reduction with either K-wires or interfragmentary screws.1
  • Thumb distal phalanx transverse shaft fractures are potentially unstable, as the fracture can angulate with its apex anterior secondary to the pull of the FPL on the proximal fragment. If reduction cannot be held in a splint, it is reasonable to insert a longitudinal K-wire percutaneously across the fracture and into the head of the proximal phalanx.1
  • For tuft fractures in which surgery is indicated, the fragment should be large enough to accept a screw or K-wire to avoid fracturing the fragment.
    • In general, this means the fragment should be more than 4 mm wide and not be comminuted.
    • In fractures where the fragments are large, 2 screws or K-wires may be inserted.22

Post-treatment Management

  • The care and precautions related to immobilization devices for the thumb distal phalanx fracture must be carefully reviewed with the patient. Patients should be educated regarding care and precautions. Patients should know that pain, especially increasing pain, numbness, tingling, skin irritation, splint loosening, or excessive splint tightness are red flags and should be reported to the surgeon or his team.
  • Pain should be managed with properly fitting splints, reassurance, elevation, ice in the initial post-fracture period, and mild pain medications. Patients should be encouraged to discontinue pain medication as soon as possible. Opioid use should be kept to a minimum.
  • Joints that are splinted for closed stable fractures are usually immobilized.
  • Fractures that require internal fixation can be mobilized after 4 weeks.
  • If an infection does occur, management should focus on eradicating sepsis with thorough debridement, appropriate antibiotics (eg, cephalosporin, penicillin), and fracture stabilization, followed by obtaining fracture union and regaining a functional extremity.1
  • Patients should be instructed to carefully exercise all joints in the injured hand that do not require immobilization. Patients usually can exercise on their own; however, signs of generalized thumb or hand stiffness are indications for referral to hand therapy (PT or OT).
CPT Codes for Treatment Options

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Common Procedure Name
ORIF proximal phalanx
CPT Description
Open treatment phalangeal shaft fracture proximal/mid finger/thumb w/wo fixation each
CPT Code Number
26735
CPT Code References

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Complications
  • Stiffness is the most common complication of hand fractures,5,10 but thumb distal phalanx fractures can usually be immobilized rapidly enough to avoid this.
  • Malunion and fingertip deformity after thumb distal phalanx fractures is rare but can occur, especially in open, severe, unstable fractures.23 Nonunions are also rare, and guidelines for treating these complications do not exist. Malunions with malrotation are also possible.22
  • Posttraumatic osteoarthritis can occur in the IP joint after some thumb distal phalanx fractures (eg, large displaced mallet thumb fracture).
  • Osteomyelitis of the thumb distal phalanx is rare but can occur in open thumb distal phalanx fractures, especially in patients with diabetes or in patients whose immune system is compromised.
  • Owing to the compensatory movement of the adjacent joints, the thumb is more forgiving of residual deformity than the other digits.1
Outcomes
  • Most outcomes after thumb distal phalanx fractures are very good.5,10,24 Fortunately, the complications noted above are rare. Significant stiffness can usually be avoided because the metacarpophalangeal (MP) joint of the thumb can be mobilized while the IP joint and distal phalanx are splinted. 
  • In general, the prognosis for thumb distal phalanx fractures and fracture-dislocations has a great deal to do with the amount of energy associated with the original injury.
    • High-energy injuries often produce comminution, articular surface damage, and extensive soft tissue injury, which predispose patients to degenerative changes and stiffness, and usually lead to poor outcomes.
    • Low-energy injuries with simple fracture patterns and limited soft tissue involvement are associated with an excellent prognosis.
Key Educational Points
  • Thumb distal phalanx fractures must be mobilized before radiographic fracture healing is complete to avoid disabling stiffness.
  • Immobilization of thumb distal phalanx fractures for >4 weeks is rarely needed.1
  • Most thumb distal phalanx fractures can be treated without surgery.1,7
  • Underlying pathological conditions such as bone tumors (eg, enchondromas) and osteoporosis should be expected in fractures that occur from trivial trauma.
  • The functional needs of each patient must be considered when recommending treatment for finger fractures.
  • The management of extra-articular thumb phalanx fractures differs from that of finger phalanx fractures in that some angular displacement or malunion is acceptable due to the compensatory motion of the thumb MP joint.25
References

New and Cited Articles

  1. Day CS. Fractures of the Metacarpals and Phalanges. In: Green DP, ed. Green's Operative Hand Surgery. Seventh ed. Philadelphia: Elsevier; 2016, pp. 231-77.
  2. Harness NG, Meals RA. The history of fracture fixation of the hand and wrist. Clin Orthop Relat Res 2006;445:19-29. PMID: 16505723
  3. Karl JW, Olson PR, Rosenwasser MP. The Epidemiology of Upper Extremity Fractures in the United States, 2009. J Orthop Trauma 2015;29:e242-4. PMID: 25714441
  4. Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg 1993;Dec;27(4):317-9. PMID: 8159947
  5. Cheah AE, Yao J. Hand Fractures: Indications, the Tried and True and New Innovations. J Hand Surg Am 2016;41:712-22. PMID: 27113910
  6. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am 2004;29:1128-38. PMID: 15576227
  7. Walenkamp MM, Vos LM, Strackee SD, Goslings JC, Schep NW. The Unstable Distal Radius Fracture-How Do We Define It? A Systematic Review. J Wrist Surg 2015;4:307-16. PMID: 26649263
  8. Kadow TR, Fowler JR. Thumb Injuries in Athletes. Hand Clin 2017;33(1):161-173. PMID: 27886832
  9. Ketonis C, Dwyer J, Ilyas AM. Timing of Debridement and Infection Rates in Open Fractures of the Hand: A Systematic Review. Hand (NY) 2017;12:119-26. PMID: 28344521
  10. Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am 2013;38:1021-31. PMID: 23618458
  11. Oflazoglu K, Moradi A, Braun Y, et al. Mallet Fractures of the Thumb Compared With Mallet Fractures of the Fingers. Hand (NY) 2017;12(3):277-282. PMID: 28453351
  12. Tabbal GN, Bastidas N, Sharma S. Closed mallet thumb injury: a review of the literature and case study of the use of magnetic resonance imaging in deciding treatment. Plast Reconstr Surg 2009;124(1):222-6. PMID: 19568085
  13. Doyle JR. Extensor tendons-acute injuries. In: Green DP (ed.) Operative Hand Surgery. New York: Churchill Livingstone; 1982, pp. 2045–72.
  14. Norrie BA, Jebson PJ. Mallet thumb. J Hand Surg Am 2013;38(6):1219-21. PMID: 23540415
  15. Abe Y, Rokkaku T, Tokunaga S, et al. Closed mallet thumb injury: Our experience of 10 patients treated with surgery and a systematic review. J Plast Reconstr Aesthet Surg 2016;69(6):835-842. PMID: 27075490
  16. Naito K, Sugiyama Y, Igeta Y, et al. Irreducible dislocation of the thumb interphalangeal joint due to displaced flexor pollicis longus tendon: case report and new reduction technique. Arch Orthop Trauma Surg 2014;134(8):1175-8. PMID: 24902518
  17. Engber WD. Volar plate arthroplasty of the thumb interphalangeal joint. Iowa Orthop J 2000;20:75-8. PMID: 10934628
  18. Brown DJ, Parcells AL, Granick MS. Thumb Interphalangeal Joint Dislocation. Eplasty 2016 Jan;16:ic2. PMID: 26816560
  19. Mansha M, Miranda S. Early results of a simple distraction dynamic external fixator in management of comminuted intra-articular fractures of base of middle phalanx. J Hand Microsurg 2013;5(2):63-7. PMID: 24426677
  20. Stanton JS, Dias JJ, Burke FD. Fractures of the tubular bones of the hand. J Hand Surg Eur Vol 2007;32(6):626-36. PMID: 17993422
  21. Meijs CM, Verhofstad MH. Symptomatic nonunion of a distal phalanx fracture: treatment with a percutaneous compression screw. J Hand Surg Am 2009;34(6):1127-9. PMID: 19442455
  22. Hay RA, Tay SC. A Comparison of K-Wire Versus Screw Fixation on the Outcomes of Distal Phalanx Fractures. J Hand Surg Am 2015;40(11):2160-7. PMID: 26433243
  23. Kaplan SJ. Bony complications caused by stack splints. J Hand Surg Am 2013;38:2305-6. PMID: 24207001
  24. Yoon JO, Baek H, Kim JK. The Outcomes of Extension Block Pinning and Nonsurgical Management for Mallet Fracture. J Hand Surg Am 2017;42:387 e1- e7. PMID: 28274605
  25. Carlsen BT, Moran SL. Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am 2009;34(5):945-52. PMID: 19411003
  26. Husain SN, Dietz JF, Kalainov DM, Lautenschlager EP. A biomechanical study of distal interphalangeal joint subluxation after mallet fracture injury. J Hand Surg Am 2008;33:26-30. PMID: 18261661
  27. Hofmeister EP, Mazurek MT, Shin AY, Bishop AT. Extension block pinning for large mallet fractures. J Hand Surg Am 2003;28:453-9. PMID: 12772104
  28. Shah CM, Sommerkamp TG. Fracture dislocation of the finger joints. J Hand Surg Am 2014;39:792-802. PMID: 24679912

Reviews

  1. Kadow TR, Fowler JR. Thumb Injuries in Athletes. Hand Clin 2017;33(1):161-173. PMID: 27886832
  2. Carlsen BT, Moran SL. Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am 2009;34(5):945-52. PMID: 19411003

Classics

  1. Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg 1993;27(4):317-9. PMID: 8159947
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