X-ray Imaging for Finger Fracture Evaluation

Radiographic Evaluation Protocol for Finger Fractures

A standard 3-view radiographic examination is necessary to show most fractures and dislocations of the phalanges, according to the American College of Radiology, requiring at minimum a posteroanterior (PA), lateral, and oblique views 1
For phalangeal injuries specifically, some centers include a PA examination of the entire hand, while others limit the examination to the injured finger, as recommended by the American College of Radiology 2
An internally rotated oblique projection, in addition to the standard externally rotated oblique, increases diagnostic yield for phalangeal fractures, as suggested by the American College of Radiology 1, 2
Relying on only 2 views is inadequate for detecting fractures in the fingers, and a 3-view radiographic examination is necessary, according to the American College of Radiology 1, 2

If initial radiographs are negative but clinical suspicion remains high, options include placing the patient in a short arm cast and repeating radiographs in 10-14 days, or using MRI without IV contrast, as recommended by the American College of Radiology 1, 2
For metacarpal and digital fractures, CT is usually not indicated during acute injury, according to the American College of Radiology 2
MRI without IV contrast may be considered if there is high clinical suspicion despite negative radiographs, as suggested by the American College of Radiology 1