Little finger is the most common ray involved, followed by the thumb.
Determine point of maximal tenderness. With the finger anesthetized, the examiner also gets the best possible evaluation of a possible rotation deformity of the finger, comparing the plane of the digits nails, as the patient actively flexes and extends the affected finger. Treatment of base fractures at the proximal phalanx is a compromise between fixation and mobilization in retrieval of full range of motion (ROM) of the finger.3,9–12 Surgical fixation tends to cause a substantial loss of motion when percutaneous K-wire fixation or open reduction and internal fixation is performed.13–15 Standard treatment strategy for base fractures of the proximal phalanx should focus on function and to a lesser extent exact reposition of the fractured digit. Crush or direct blow to the finger accounts for more than 80% of injuries. 1. A phalangeal fracture is the most common injury to the skeletal system and accounts for approximately 10% of all fractures. The fracture can be addressed with K-wires (1–1.25 mm) with a percutaneous technique. When evaluating a proximal phalanx fracture, it is important to pay attention to the tendon function of the involved digit, as the bottom of the flexor tendon sheath is constituted of the palmar aspect of the phalangeal bone. Stable, nondisplaced without angulation or rotational deformity, treated with buddy taping: Dynamic splinting for 3 wks; x-ray at 7–10 days to check alignment and stability, Daily ROM exercises after 1 wk as comfort allows, Continued dynamic splinting for athletic activities for another 4–6 wks. Bicondylar Proximal Phalanx Fractures. Return-to-play decision based on stability, ROM, current clinical and radiographic healing status, and specific demands of sport.
Nerve and tendon anatomy should be taken into consideration when planning pin or screw placement. Proximal phalanx fractures are the most common pediatric hand fracture 1. Cornwall R, Ricchetti ET.
2. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":41774,"mcqUrl":"https://radiopaedia.org/articles/proximal-phalanx-fracture/questions/1274?lang=us"}. Nondisplaced and impacted fractures treated with splint or cast: Recheck radiographs in 7–10 days to assess healing. When using lag screws, maximal fracture compression is obtained. Boyer JS, London DA, Stepan JG, Goldfarb CA. After reduction, immobilization should be applied and postreduction imaging should be obtained.
Intrinsic muscles of the hand (interossei) insert into the extensor expansion on the dorsum of the proximal phalanx. Plain radiographs (posteroanterior [PA] and lateral views) of the injured finger should always be performed when a fracture is suspected. Closed reduction and external fixation provides stabilization with minimal risk of worsening the soft tissue lesion caused by the trauma. In my practice “buddy taping” is always used if the fracture is non-displaced and stable, or displaced and stable after closed reduction allowing immediate mobilization ( Fig. In my practice “buddy taping” is always used if the fracture is non-displaced and stable, or displaced and stable after closed reduction allowing immediate mobilization ( Fig.
The following phalangeal fractures in children warrant prompt orthopedic consultation, since many will require immediate surgery (.
Waters PM.
When addressing a comminuted fracture, one must consider whether the soft tissues tolerate further mobilizing or not.
Upon consideration of the subsequent treatment of the fractured phalanx, stability, angulation, and possible rotation of the fracture should be observed. Evaluation of the soft tissues, nerves, and tendons of the injured finger is mandatory when the treatment method is to be determined.
Test of ligament stability is performed on the metacarpophalangeal (MP), PIP, and distal interphalangeal (DIP) joints taking a possible intra-articular base fracture of the proximal phalanx into account.
16.3). Conservative treatment and immediate mobilization are first choice for undisplaced fractures. Phalangeal neck or condyle fractures: Failure to treat this injury with pin stabilization can result in a malunion that limits digital flexion. Most athletes with stable fractures are able to return as early as 1–2 wks after the injury with protection such as buddy taping. The proximal phalanx is the phalanx (toe bone) closest to the leg.
Tags: Fractures of the Hand and Carpus In this chapter, intervention options are reviewed focusing on restoration of finger function and to a lesser extent on exact reposition of the fractured digit. A rigid osteosynthesis should be obtained, as early mobilization after 1 to 2 weeks is necessary to secure a satisfactory functional outcome ( Fig. The trauma is most likely related to sports activities in the 10-to 30-year-olds, work related in the 30- to 70-year-olds, and due to fall from a standing position in people above 70 years of age.1–3 The fracture often results in a dorsal angulation at the fracture site in the base of the proximal phalanx. The proximal articular fractures are subdivided into avulsion, shearing, and multifragmentary fractures. Unlike diaphyseal fractures, these do not tend to cause appreciable rotational deformity.
16.1).
If osteosynthesis are required to maintain an acceptable position of the fracture after closed reduction, K-wire fixation should be considered, with respect for the anatomy of the extensor apparatus. Oral analgesics may be used if needed; NSAIDs should be used with caution in acute fractures since they may impair acute fracture healing.
2.
Some use a splint in a palmar or dorsal position, fixating the wrist, MCP joint, and the entire finger, also immobilizing the adjacent finger. 16.3). Nerve lesions are usually associated to open injuries. A phalangeal fracture is the most common injury to the skeletal system and accounts for approximately 10% of all fractures. Displaced fractures, that are unstable after closed reduction, require stable pin or percutaneous screw fixation. An extra-articular transverse or oblique fracture is often the outcome of the described trauma, whereas torsion injuries might cause an oblique or spiral fracture of the shaft. Nerve lesions are usually associated to open injuries. Fractures of the metaphysis of the proximal phalanx can be transverse, oblique, or comminuted. 16.2). Check for errors and try again. Treatment can be conservative in the case of a non-displaced fracture, but the method of immobilization may vary between orthopedic surgeons.
Treatment and prognosis
If osteosynthesis are required to maintain an acceptable position of the fracture after closed reduction, K-wire fixation should be considered, with respect for the anatomy of the extensor apparatus. Feb 25, 2020 | Posted by admin in ORTHOPEDIC | Comments Off on Fractures at the Base of the Proximal Phalanx. Apply sterile dressing over any open wounds. Splint or short arm cast in the safe position (wrist dorsiflexed 30°, MCP joint flexed 70–90°, IP joints extended) for 3 wks. Radiographs should be obtained before any manipulative examination. Introduction: Treatment of base fractures in the proximal phalanx depends on the fracture type, the degree of displacement and whether fracture reduction is stable or not. Displaced or angulated transverse midshaft: Volar angulation common, generally unstable, with variable response to closed reduction, which should be attempted, Longitudinal traction and flexion of the MCP joint with manual realignment of fracture fragments, If reduction achieved/maintained, apply gutter splint or Burkhalter splint (dorsal slab of stabilizing material placed from the end of a short arm cast to just proximal to the PIP, with MCP joints flexed 70–90°). apex volar angulation if distal to FDS insertion; apex dorsal angulation if proximal to …
Internal fixation often leads to decreased mobility of the injured finger despite exact reduction of the fracture.
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