X-ray Imaging for Index Finger Injury
Order a minimum 3-view radiographic examination of the injured finger, including posteroanterior (PA), lateral, and oblique views. 1, 2, 3
Standard Imaging Protocol
A 2-view examination is inadequate and will miss fractures—you must obtain at least three views for any finger injury. 1, 3 The American College of Radiology explicitly states that radiographic examinations including only 2 views are not adequate for detecting fractures in the fingers. 1
Required Views
- Posteroanterior (PA) view: Can be obtained either of the entire hand or limited to the injured finger alone—both approaches are acceptable. 1, 3
- Lateral view: Essential for detecting displacement and alignment issues. 1, 4, 5
- Oblique view: Critical for maximizing fracture detection, as this view uniquely reveals abnormalities missed on the other two views. 1, 3, 6
Enhanced Detection with Additional Oblique View
Consider adding an internally rotated oblique projection in addition to the standard externally rotated oblique, as this increases diagnostic yield for phalangeal fractures. 1, 3 The oblique view is particularly valuable because it changes interpretation in approximately 5% of cases and increases diagnostic confidence significantly. 6
Clinical Rationale
Radiographs before any intervention are mandatory because they detect:
- Fractures and dislocations that fundamentally alter management 2
- Foreign bodies, particularly radiopaque materials 2
- Intra-articular fractures that may require surgical intervention to prevent long-term osteoarthritis 2
- Fracture fragments in tendon injuries, as large fragments may require open reduction and internal fixation 1
If Initial Radiographs Are Negative
When clinical suspicion remains high despite negative initial radiographs:
- Place the finger in a short arm cast and repeat radiographs in 10-14 days, OR 2, 3
- Consider MRI without IV contrast to detect occult fractures 2, 3
CT is usually not indicated for acute finger fractures. 3