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.
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.
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