Fractures of the phalanges are the most common fractures of the hand and are also known as bamboo fractures. The fracture can occur in the proximal, middle, or terminal segments, and can be single or multiple, mostly in adults. Fractures of the finger bone have a high incidence, accounting for the first of all fractures of the extremities and about 6 or 18% of all fractures in the body. Etiology】 Both direct and indirect violence can cause fracture of the finger bone, but most of them are caused by direct violence, and most of them are open fractures, transverse fractures, oblique fractures, spiral fractures, comminuted fractures, or fracture of the joint surface. Closed fractures are more common with transverse fractures, followed by oblique fractures. Open fractures are more common with comminuted fractures. Fractures of the proximal phalanges are mostly caused by indirect violence, and are more common in diaphyseal fractures, as the proximal end of the fracture is pulled by the bone asking muscle and the earthworm muscle, and the distal end of the fracture is pulled by the extensor tendon, which often results in an angular deformity to the palmar side. In case of neck fracture, the distal uncle can rotate up to 90° to the dorsal extension due to the pulling of the extensor tendon, so that the dorsal side of the distal end is opposite to the proximal section, which hinders the fracture rectification. 2.Middle phalangeal fracture The middle phalangeal fracture can cause transverse fracture by direct violence, and oblique or spiral fracture by indirect violence. Due to different fracture sites, different deformities can occur. If the fracture site is proximal to the superficial flexor cusp, the distal fracture end is pulled by the superficial flexor tendon, resulting in an angular deformity to the dorsal side. If the fracture site is on the distal side of the superficial flexor tendon stop, the proximal fracture end is displaced to the palmar side due to the pulling of the superficial flexor tendon, forming an angular deformity to the palmar side. 3. In mild cases, there is only bone fracture, but in severe cases, it can be cracked into a bone block. Mostly combined with soft tissue laceration. The fracture is usually not significantly displaced or deformed due to local dead tendon pulling. The dorsal avulsion of the base of the terminal phalanx is mostly due to the sudden flexion of the terminal phalanx by indirect violence when the finger is straightened, and the avulsion fracture of the dorsal base of the terminal phalanx can occur due to the pull of the extensor tendon. After the fracture, the end finger is flexed, showing a typical “hammer finger” deformity. Clinical manifestations】 The fracture may be transverse, oblique, spiral, comminuted, or affected by the joint surface. After fracture, local pain, swelling, and limited extension and flexion of the finger. In case of obvious displacement, the proximal and middle phalanges may have angular deformity, and the dorsal avulsion fracture of the base of the last phalanx may have hammer-like deformity, and the finger cannot be straightened actively. A bone rubbing sound can be detected and there is abnormal activity. Diagnosis】 Local swelling, pain, and limitation of finger flexion and extension after fracture. In case of significant displacement, the proximal and middle phalanges may have angular deformity; the dorsal avulsion fracture of the base of the terminal phalanx has hammer-like finger deformity and the finger cannot be actively extended. X-ray examination can clarify the fracture site and type. 1.Inquire about the injury, including the cause, time, location, body position and what part of the body hit the ground first. 2.Comprehensive physical examination Pay attention to the presence of shock, soft tissue injuries, bleeding, check the size, shape, depth and contamination of the wound. With or without bone end exposure, with or without nerve, vascular, cranial, visceral injury and other parts of the fracture. For serious injuries must be carried out quickly. 3.X-ray examination In addition to frontal and lateral x-ray, special body positions should be taken according to the injury, such as open position (upper cervical spine injury), dynamic lateral position (cervical spine), axial position (navicular bone, heel bone, etc.) and tangential position (patella). For complex pelvic fractures or suspected intra-vertebral fractures, body films or CT examinations should also be performed as appropriate. Treatment】 The fracture must be correctly repositioned and anatomically repositioned as far as possible, without angular, rotational or overlapping displacement deformity, so as not to prevent the normal sliding of tendons and cause different degrees of finger dysfunction. Closed fractures can be repositioned by manipulation and splinting. Open fractures of the finger bone should be thoroughly debrided and then repositioned for fixation. The distal end of the fracture should be used to the proximal end during repositioning. The finger should be fixed in a functional position as much as possible, both for adequate fixation and for proper movement. For unsuccessful manual repositioning or unstable oblique fractures, surgical treatment may be considered. For manual repositioning of proximal phalangeal fractures, the patient is placed in a sitting position with the operator’s thumb and index finger pinching the proximal end of the fracture and the thumb and index finger of the other hand tugging on the distal end of the fracture. Then, the thumb is placed on the palmar side of the fracture as a fulcrum, and the patient is repositioned by continued traction and flexion of the affected limb. In the revision of the phalangeal neck, the distal segment is held to the dorsal side in 90° traction, and then the thumb is used to press the palmar side of the proximal end of the fracture and flex it to reset it. If the fracture is above the attachment point of the flexor digitorum superficialis, the fracture should be extracted and traction should be applied in the straight position, and then the lateral displacement and the palmar and dorsal angulation should be corrected by squeezing and pressing respectively. If the fracture is below the attachment point of the flexor digitorum superficialis, it should be repositioned by traction in the varus position. In the revision of terminal phalanx and diaphyseal fractures, the thumb and index finger are used to pinch and squeeze the fracture medially, laterally, and dorsally on the palm to correct lateral and palmar displacement. In the revision of basal dorsal extension avulsion fractures of the terminal phalanx, the fracture can be repositioned by flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint. Fixation methods Except for fractures of the phalanges with the fracture site distal to the stop of the superficial flexor tendon of the finger. The affected limb should be fixed in the functional position, and the finger should not be fixed in full extension to avoid joint stiffness caused by contracture of the joint capsule and lateral collateral ligaments; non-displaced fractures can be fixed in the functional position for about 4 weeks with a plastic bamboo splint or aluminum plate. For displaced proximal phalangeal stem or phalangeal neck fractures, a small flat pad, the length of which is equivalent to the phalangeal bone and does not exceed the phalangeal joint, is placed after repositioning and then fixed with adhesive tape. For fractures with metacarpal angulation, a bandage roll or small cylindrical fixation can be placed, with the fingers flexed on it so that the hand is in a functional position, fixed with adhesive tape, and wrapped with a bandage. After resetting the middle phalangeal fracture, if the fracture site is at the distal end of the stop of the superficial flexor tendon, the fixation method is the same as that of the proximal phalangeal fracture; if the fracture site is at the proximal side of the stop of the superficial flexor tendon, the finger should be fixed in the straightened position, but not for too long; after resetting the end of the terminal phalangeal or the trunk of the finger, a plastic bamboo splint or aluminum plate can be used to fix the fracture in the functional position; after resetting the basal dorsal avulsion fracture of the terminal phalangeal, the affected finger can be fixed in the functional position. In the early stage, it is advisable to activate blood circulation, eliminate blood stasis, reduce swelling and pain, and take internal medicine such as “one side of limb injury” or “seven percent”. In the middle stage, it is recommended to connect the bones and renew the damage. In the later stage, if there is no concurrent evidence, medicine can be dispensed with. After release of fixation, the affected hand can be fumigated with water from the upper limb washing formula or the decoction of Eight Immortals Free and Easy Soup. Prognosis】 Fractures of the finger bone must be treated with care. For unstable fractures, it is recommended to reset the internal fixation surgically as soon as possible. Otherwise, it will affect the function of the finger. Doctors Wu Wei, Li Xu, Xu Xian and Yuan Feng of the Department of Orthopaedics of Oriental Hospital have carried out incisional repositioning and internal fixation of finger bone fractures and surgery of the pendulous finger with very good results.