Lesser toe fractures

These are phalanx fractures involving either the articular surface or the diaphysis of the phalanges.

Articular fractures can be complete or partial articular with varying degrees of comminution.

Diaphyseal injuries can be simple or multifragmentary.

An axial load to the toe usually causes these injuries.

Unlike the low energy required to generate a simple fracture, multifragmentary fractures derive from high-impact trauma.

Fractures of the lesser toes may also result from the patients being barefoot and catching their toes on fixed objects, which forces the toes into abduction.

Conventional radiographs of the forefoot in AP and lateral oblique views are sufficient for diagnosis and treatment.

This image shows an x-ray of the comminuted base of the first and second proximal phalanges.

The clinical picture includes swelling, ecchymosis. In some fractures, a deformity may be present.

Closed fractures may look harmless on x-rays, but the nail bed has been torn in most cases.

Flexor and extensor tendons displace the fracture with a typical plantar angulation of the tuft fragment.