In the foot, the distal phalanges are flat on their dorsal surface. It is proximal the largest and narrows to the distal end. The proximal part of the phalanx has a broad base for articulation with the middle phalanx and an enlarged distal limb to support the tip of the nail and toe. [10]: 6b. 3. The phalanx ends in a rough, crescent-shaped cap of the bony epiphysis – the apical tuft (or tuberosity/nail process) that covers more of the phalanx on the volar side than on the dorsal side. Two lateral ongual spines protrude near the apical tuft. Near the base of the tree there are two lateral tubercles. Between the two, a V-shaped ridge, which extends proximalously, serves to insert the longus flexor pollicis. Another ridge at the base is used for the appearance of extensoraponeurosis.
[13] The bending site is flanked by two pits – the distal nail fossa and the proximopalmar proximal fossa. What categories of distal phalangeal fractures are described? Search for associated fracture fragments, usually from the ulnar base of the proximal phalanx AnatomyThe distal phalanx is divided into three anatomical areas: the closest to the epiphyseal region (base), followed by the diaphysis (âtaille) and finally the nail tuberosity (âtuftâ). dorsal dislocation of the proximal phalanx; ± Osteochondral shear fracture or avulsion Distal phalanges are the most exposed phalanges and are therefore more often fractured than other hand fractures. The long finger is the most involved finger, and the thumb is the second largest.1 Most distal phalangeal fractures are the result of crushing injuries, such as: Closing the finger in a door, sports injuries or workplace accidents.14 Soft tissue injuries include nail bed injuries, back tears of the skin and hematomas. If the fracture is mainly located on the distal stem of the phalanx, the tip is usually dorsal due to the volar traction of the FDP tendon.2 The distal phalanx is the most exposed and therefore more susceptible to fractures than other bones of the hand, especially P3 of the long finger. Crushing is the usual mechanism, such as closing a finger in a door, jamming it in machinery, or being kicked during exercise.14 Soft tissue injuries can include trauma to the nail bed, hematoma, digital nerve damage, and/or tearing of the dorsal skin and extensor tendons. Distal phalangeal fractures can affect the tuft or stem of the phalanx. If the P3 shaft is broken, the apex exits the FDP ridge due to opposite volar compression traction.1 Fig. Fig. 23.9 shows an intra-articular fracture of the base of the distal phalanx with dorsal angles produced by destabilizing FDP forces opposite those of the terminal tendon. In the distal phalanges of the hand, the centers of the bodies appear at the distal ends of the phalanges, rather than in the middle of the bodies, as in the other phalanges.
In addition, of all the bones of the hand, the distal phalanges are the first to ossify. [10]: 6b. 3. The nail bed is often involved in crushing injuries, and nail bed injuries are often accompanied by subungual hematomas. After this type of injury, the nail must be removed so that the nail bed can be repaired. This should be done with a fine, absorbable suture. Distal phalanx fractures rarely require more than a simple splint to protect themselves. In the event of significant displacement, open or closed reduction and fixation may be necessary. In Neanderthals, apical tufts were dilated and more robust than in the modern Upper Paleolithic and early Paleolithic. A suggestion that Neanderthal alpha distal lengths were an adaptation to a colder climate (than in Africa) is not supported by a recent comparison showing that in hominids, cold-adapted populations had smaller apical tufts than warm-adapted populations. [15] The term phalanx or phalanx refers to an ancient formation of the Greek army in which soldiers stand side by side, several rows deep, like an arrangement of fingers or toes.
The distal phalanx of the index finger, the distal end of the radius, and the olecranial process of the ulna are important sites for testing vibration in the upper limb. Buttonhole injury: PIP flexion with PIP extension due to a central sliding injury of the extensor tendon; ± dorsal avulsion middle phalangeal base An obliquely oriented axial compression force sometimes leads to a dorsal marginal fracture that covers about half of the articular surface and can interfere with collateral ligaments. In such cases, traction of the flexor digitorum profundus results in palmar subluxation of the distal phalanx. This violation is a strong indication of ORIF. What structure is often injured in distal phalanx crushing wounds? The phalanges /fəˈlændʒiːz/ (singular: phalanx /ˈfælæŋks/) are digital bones in the hands and feet of most vertebrates. In primates, the thumbs and big toes have two phalanges, while the other fingers have three phalanges. The phalanges are classified as long bones. Distal phalanges are conical in most mammals, including most primates, but relatively large and flat in humans. The morphology of the distal phalanges of the human thumbs reflects an adaptation for a refined precision grip with pad to pad contact.
This has traditionally been associated with the advent of stone tool making. However, the intrinsic hand proportions of australopites and the similarity between human hands and short hands of Miocene apes suggest that the proportions of the human hand are largely plesiomorphic (as found in ancestral species) – unlike the derived pattern of the elongated hand and poorly developed thumb muscles of other recent hominids. [12] What is the treatment for distal phalangeal fractures? Bones of the toes or phalanges of the foot. Note that the big toe does not have a median phalanx. People vary; Sometimes the smallest toe does not have one (not in the photo). [1] Distal phalanx fractures in pediatric patients are logically classified as extraphyseal or physical. Treatment of extraphyseal fractures of the distal phalanx in children is similar to that of adults and is based on the stability of the fracture pattern and the condition of the nail bed. Closed fractures with an intact nail bed are treated with a splint of the DIP joint and the distal phalanx in extension for 3 to 4 weeks until clinical healing of the fracture site. The PIP seal should be left free for normal ROM. The patient may need a protective splint for contact activities for another 2 weeks. If the nail bed is torn, a digital nerve block is performed; removed the nail plate; and the nail bed debrides, irrigates and repairs. Nail bed repair usually requires thin absorbable suture material (for example, 7-0 chromic).
Unstable fractures (e.g. transverse fractures that are not reproducible by closed means) should be referred to an orthopaedic surgeon. Complications of distal phalangeal fractures in pediatric patients include osteomyelitis and nail bed abnormalities. A patient with any of these complications should be referred to an orthopedic surgeon for final treatment. Volar plaque injury: Usually injured distal Volar plate; ± volar avulsion of the base of the middle phalanx In non-human primates, phylogeny and locomotion style appear to play a role in apical tuft size. Suspensory primates and New World monkeys have the smallest apical tufts, while terrestrial quadrupeds and strepsirrhine have the largest. [15] A study of the fingertip morphology of four small New World monkey species showed a correlation between increased smallarm foraging and reduction of flexor and extensor tubercles in the distal phalanges and extensive distal parts of the distal phalanges, coupled with enlarged apical pads and developed epidermal ridges. This suggests that extensive distal phalanges were developed in arboreal primates rather than four-legged terrestrial primates. [16] Often associated with significant soft tissue injury due to a narrow soft tissue envelope in distal figures The distal phalanx is divided into three anatomical parts: proximal the metaphysis (base), followed by the diaphysis (âshaftâ) and finally the nail tuberosity (âtuftâ). The base of the distal phalanx has a prominent dorsal crest at the beginning of the extensor tendon. The tendon also adheres to the distal interphalangeal joint capsule (PID). On the palmar surface is the insertion of the tendon Flexor digitorum profundus.
This also adheres to the Volarplatte. The flexor tendon settles over the entire width of the base of the distal phalanx. The Volar plate is very flexible and allows excessive stretching of the DIP joint and pulp-to-pulp pinching.