Home » MSK Ultrasound case studies » Avulsion injury of the distal phalanx – Sophie Cochran – MSK Sonographer / Stuart Wildman – Extended Scope Physiotherapist
Disruption and displaced cortical fragement of the distal phalanx

Avulsion injury of the distal phalanx – Sophie Cochran – MSK Sonographer / Stuart Wildman – Extended Scope Physiotherapist

This post will outline two cases of the sonographic presentation of an avulsion injury to the distal phalanx. For the first time we have had two cases presented,with thanks to Sophie Cochran for sending her case into The Ultrasound Site to contribute!

Case 1

This patient in their early 30's, presented with a left 3rd metacarpal injury.  She recalled falling over and feeling pain and discomfort in the distal interphalangeal joint. She also noticed an inability to extend her finger fully. On examination, she presented with a mallet finger, and no activation of DIP extension.

On ultrasound in clinic, there was disruption to the distal insertion of the extensor tendon onto the distal phalanx, with an area of cortical irregularity. The sonographic appearance and clinical presentation was suggestive of an avulsion injury of the distal phalanx.

Disruption and displaced cortical fragment of the distal phalanx


Longitudinal view of the distal pahalanx, and the corresponding transverse view showing the fragment.

The patient was referred for an x-ray (See below) to confirm the ultrasound images, and the report indicated:

'There is a non united avulsion fracture of the proximal segment of the distal phalanx, major finger left hand. '


This patient was subsequently seen in fracture clinic and then had ongoing hand clinic input.

Case 2

A further case is illustrated below, contributed by Sophie Cochran, MSK Sonographer. The patient presented reporting a history of trauma. On Sunday morning they attended A&E and an x-ray of the hand showed no obvious bony injury – on retrospectively viewing the image you are unable to see the region of interest due to finger overlap. They were subsequently referred to the fracture clinic for review and an ultrasound demonstrated the images below of an avulsion.

Hyperechoic avulsion fragment visible superficial to the DIP joint
Cortical irregularity of the DIPJ normal outline, suggestive of avulsion

Articles of interest

Moschilla & Breidah (2003) Sonography of the finger, American Journal of Roentgenology

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