The five proximal phalanges are the first bones of each finger, articulating with the metacarpals at the metacarpophalangeal joints and with the middle phalanges at the proximal interphalangeal joints.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | Endochondral ossification with proximal epiphyses appearing between ages 1 and 3. |
Proximal phalanx fractures are common finger injuries from axial loading or direct blows during sport. Oblique and spiral fractures can produce rotational deformity detectable by checking that all nails lie in the same plane with the fingers flexed. The central slip of the extensor mechanism inserts at the PIP joint level, and damage to the extensor hood at this level produces boutonniere deformity. Crush injuries to the proximal phalanx producing comminuted fractures in the zone of the flexor tendon sheath require careful management to avoid permanent stiffness.
These fractures tend to angulate with the apex pointing to the palm because of the pull of the interossei and the central slip, and rotation must be corrected.
A tear of the ulnar collateral ligament of the thumb MCP joint may avulse a fragment from the base of the proximal phalanx.
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