Distal Interphalangeal Joint and Fractures of the Distal Phalanx

  • Subodh DeshmukhEmail author
  • Christopher Armitstead


In this chapter we address injuries to the tips of the fingers and the disorders of the distal interphalangeal joint. It is important to appreciate that trauma to this area produces a variety of injury patterns, not only to the distal phalanx itself, but also to the other surrounding non-bony structures (Fig. 7.1). Injury to the tip of the finger is common and accounts for approximately half of all hand injuries [1] and is usually the result of a sporting, occupational or domestic accident. These injuries are important to recognise and treat appropriately to maintain hand function and prevent permanent disability.


Distal phalanx DIPJ Fractures Dislocation Amputation Subungual haematoma Nail avulsions Nail bed lacerations Mallet finger Jersey finger 


  1. 1.
    Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg. 1993;27(4):317–9.PubMedGoogle Scholar
  2. 2.
    Zook EG. Anatomy and physiology of the perionychium. Hand Clin. 1990;6:1–7.PubMedGoogle Scholar
  3. 3.
    Zook EG. Fingernail injuries. In: Strickland JW, Steichen JB, editors. Difficult problems in hand surgery. St. Louis: CV Mosby; 1982.Google Scholar
  4. 4.
    Seaberg DC, Angelos WJ, Paris PM. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med. 1991;9:209–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Schneider LH. Fractures of the distal phalanx. Hand Clin. 1988;4:537–47.PubMedGoogle Scholar
  6. 6.
    Seymore N. Juxta-epiphyseal fracture of the terminal phalanx of the finger. J Bone Joint Surg (Br). 1966;48(2):347–9.Google Scholar
  7. 7.
    Day CS, Stern PJ. Chapter 8. Fractures of the metacarpals and phalanges. In: Green’s operative hand surgery, vol. I. 6th ed. Elsevier: Churchill Livingstone; Philadelphia 2010. p. 239–90.Google Scholar
  8. 8.
    Hamas RS, Horrell ED, Pierret GP. Treatment of mallet finger due to intra-articular fracture of the distal phalanx. J Hand Surg [Am]. 1978;3:361–3.CrossRefGoogle Scholar
  9. 9.
    McCue 3rd FC, Wooten SL. Closed tendon injuries of the hand in athletics. Clin Sports Med. 1986;5:741–55.PubMedGoogle Scholar
  10. 10.
    Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. J Hand Surg [Am]. 1977;2:66–9.CrossRefGoogle Scholar
  11. 11.
    Henry SL, Katz MA, Green DP. Type IV FDP avulsion: lessons learned clinically and through review of the literature. Hand (N Y). 2009;4(4):357–61.CrossRefGoogle Scholar
  12. 12.
    Fox J, Golden G, Rodeheaver G, Edgerton M, Edlich R. Nonoperative management of fingertip pulp amputation by occlusive dressings. Am J Surg. 1977;133(2):255–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Moienem NS, Elliot D. Composite graft replacement of digital tips. A study in children. J Hand Surg (Br). 1997;22(3):346–52.CrossRefGoogle Scholar
  14. 14.
    Wilhelmi BJ, Blackwell SJ, Miller JH. Do not use epinephrine in digital blocks: myth or truth? Plast Reconstr Surg. 2001;107:393–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Chowdhry S, Seidenstricker L, Cooney D. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126(6):2031–4.PubMedCrossRefGoogle Scholar
  16. 16.
    NHS Rapid Response Report NPSA/2009/RRR007: reducing risks of tourniquets left on after finger and toe surgery, December 2009Google Scholar
  17. 17.
    Teoh LC, Lee JYL. Mallet fractures: a novel approach to internal fixation using a hookplate. J Hand Surg (Br & Eur). 2007;32(1):24–30.CrossRefGoogle Scholar
  18. 18.
    Theivendran K, Mahon A, Rajaratnam V. A novel hook plate fixation technique for the treatment of mallet fractures. Ann Plast Surg. 2007;58(1):112–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Chim H, Teoh LC, Yong FC. Open reduction and interfragmentary screw fixation for symptomatic nonunion of distal phalangeal fractures. J Hand Surg (Eur). 2008;33(1):71–6.CrossRefGoogle Scholar
  20. 20.
    DaCruz DJ, Slade RJ, Malone W. Fractures of the distalphalanges. J Hand Surg (Br). 1988;13:350–2.CrossRefGoogle Scholar
  21. 21.
    Kocak E, Carruthers KH, Kobus R. Distal interphalangeal joint arthrodesis with the Herbert headless compression screw: outcomes and complications in 64 consecutively treated joints. Hand (N Y). 2011;6(1):56–9.CrossRefGoogle Scholar

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© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Trauma and OrthopaedicCity HospitalBirminghamUK
  2. 2.Department of Hand SurgeryLeighton HospitalCreweUK

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