Authors of section


Matej Kastelec, Pavel Dráč

Executive Editor

Simon Lambert

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Multifragmentary fractures of the diaphysis and distal end segment


Wedge and multifragmentary fractures of the shaft and tuft are classified by the AO/OTA as 78.2–5.3.2B/C, where 2–5 indicates the finger involved.

In multifragmentary fractures, the comminution may be limited to the tuft or extend into the diaphysis.

Shaft fractures may be wedge or comminuted.

Multifragmentary fractures of the diaphysis and distal end segment of the distal phalanx

Further characteristics

Fractures of the distal phalanx are the most common fractures in the hand.

Most of these fractures result from direct impact or crush injuries with associated soft-tissue (nail bed or pulp) lacerations. Most frequently, there is a comminuted tuft fracture.

Common complications of these injuries are:

  • Altered sensibility (numbness, hyperesthesia, tenderness)
  • Cold hypersensitivity (cold intolerance)
  • Restriction of DIP joint movement
  • Nail growth abnormalities

Classification of distal phalangeal fractures (after Schneider)

Schneider divides distal phalangeal fractures into tuft, shaft, and articular fractures.

Tuft fractures include

  • Simple fractures
  • Comminuted fractures

Shaft fractures include

  • Transverse fractures
  • Longitudinal fractures (may extend to involve the DIP joint)

Articular fractures include

  • Palmar (flexor digitorum profundus avulsion fractures)
  • Dorsal (extensor avulsion, mallet fractures)
Fracture pattern in the distal phalanx after Schneider


AP and lateral view x-rays should be taken.

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