The five distal phalanges carry the fingernails and fingertip skin, providing the terminal attachment for the flexor and extensor digitorum tendons and containing the sensory nerve endings critical for fine motor control and grip.
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| Landmarks |
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| Ossification | Endochondral ossification, with distal phalanges having the most variable and sometimes absent distal epiphyses. |
Distal phalanx fractures are the most common hand fractures, usually from crush injuries producing tuft fractures that heal well conservatively but are exquisitely painful from the subungual haematoma (blood under the nail) that requires evacuation by trephining the nail. Mallet finger from avulsion of the terminal extensor tendon at the distal phalanx base requires 6 to 8 weeks of DIP extension splinting. Jersey finger avulsion of the FDP from the distal phalanx requires surgical reattachment.
A crush injury, such as a finger caught in a door, fractures the tip of the distal phalanx and often accompanies a nail bed laceration.
Forced flexion of the extended fingertip ruptures or avulses the extensor tendon from the base of the distal phalanx, causing a drooping fingertip.
Forced extension during gripping avulses the flexor digitorum profundus from the base of the distal phalanx, most often in the ring finger.
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