Treated differently to other fractures have their own protocol often associated with a dislocation injury therefore need to assess for other structural damage ie collateral ligaments and adjust treatment accordingly protected mobilisation indicated immediately post fracture. Middle phalanx fractures are the least common of the phalanx fractures. Principles of metacarpal and phalangeal fracture management jospt. Finger distal phalanx fractures including mallet finger fracture, fdp tendon avulsion fracture and dip joint volar plate avulsion fracture.
Perform gentle range of motion activities of the fingers. Nhs trust physiotherapy department phalangeal fractures. It is also possible for a tumor or cyst to weaken the bone, causing it to break easily when injured. Antegrade jointsparing intramedullary wiring for middle phalanx shaft fractures article in the journal of hand surgery 398 may 2014 with 17 reads how we measure reads. A method of qualifying this is lack of discomfort when direct manual. A distal phalanx fracture is a disruption of the mechanical integrity of the distal phalanx. Another fracture of the proximal phalanx shaft showing prcciperativc and post operative positions and an xray showing the desired position of the finger in plaster. However, sometimes, to achieve the best possible outcome, it. Sometimes just taping the broken finger to the uninjured fingers next to it will be enough. Pdf management of proximal phalangeal fractures of the. These fractures often heal well with benign neglect. What is the role of surgery in the treatment of middle. If you break one of these bones you have a phalangeal fracture. Toe and forefoot fractures can result from a direct blow to your footsuch as dropping a heavy object on your toes.
These injuries are commonly caused by hyperextension of the finger causing an avulsion fracture of the volar plate. Radiographic features these fractures are generally well visualized on plain radiographs. The fracture is nondisplaced, meaning the pieces of bone on either side of the break are not pushed. Middle phalanx pip joint small fragment avulsion of. Pdf management of phalangeal fractures of hand researchgate. Throbbing pain is characteristic, and dependent position may worsen the pain.
A broken finger also known as a phalanx fracture is a very common hand injury. Uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency medicine, endocrinology and diabetes, family medicine, gastroenterology and hepatology, hematology, infectious diseases, nephrology and hypertension, neurology, obstetrics, gynecology, and women. They have different prognosis and treatment depending on the location of the fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. The break is in one of the three small bones in each finger. Fractures of the base of the middle phalanx of the finger classification, management and longterm results noritaka seno, hiroyuki hashizume, hajime inoue, junya imatani, yoshiaki morito from okayama university medical school and okayama saiseikai general hospital, japan we classi. Phalanx fractures typically occur after an object has been dropped on the toes. To put it simply, you have a crack in a finger bone. Best, md, phd, the ohio state university, columbus, ohio. Common hand injuries, splinting, and therapy stephan kulzer, otrl, cht andrea ransom, otrl, cht june 10th, 2016. Often, in addition to hyperextension, axial pressure applied to the fingertip, causes longitudinal compression forces on the middle phalanx towards the proximal phalanx.
A direct blow commonly causes proximal phalanx fractures but rotational forces and hyperextension can also cause injury. Fractures of the distal phalanx are the most common fractures that occur in the hand. Anatomy of special importance to middle phalanx fractures is described below. Deep to the flexor tendons the volar plate provides. Family practice notebook 2020, family practice notebook, llc. A phalanx fracture can happen when your finger or toe is hit, pulled, jammed, crushed, or twisted. Ulnar gutter, or buddy taping acceptable if the injury is a nondisplaced fracture through the phalangeal shaft distal phalanx fracture. We help you diagnose your middle phalanx case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Nondisplaced phalanx fractures are managed with splint immobilization. Middle phalanx fracture oblique 46 middle phalanx fracture oblique 47 summary and recs majority of phalanx fractures should be treated non operatively early motion is key. Pdf intramedullary headless screw fixation for fractures. Fractures of the middle phalanx may involve the palmar lip or the dorsal lip or may be a pilon type of injury involving both the palmar and the dorsal lip with extensive intraarticular comminution.
The periarticular nonunion of the middle phalanx of the index finger was treated with distal interphalangeal arthrodesis. The goal of proximal phalangeal fracture management is to. Distal phalanx fractures are treated conservatively, and middle phalanx fractures can be treated if reduction is. A phalanx fracture is a crack or complete break in one of these bones. Operative treatment of metacarpal and phalangeal shaft fractures. Dorsal dislocation of the proximal interphalangeal joint is the most common type of finger dislocation. The proximal phalanx is the toe bone that is closest to the metatarsals. Proximal phalanx fractures are often angulated at the time of presentation independent of mechanism as muscle forces deform the unstable shaft. Middle phalangeal fractures are less predictable with regard to angulation, as extensor and flexor forces traverse the midportion of the middle phalanx. The goals for hand therapy following a metacarpal or phalanx open reduction and internal fixation orif is to regain full range of motion, decrease pain, progress to strengthening activities and return to functional activities. A distalthird fracture tends to angulate with an apex volar deformity from the action of the. For proximal phalanx fractures, a handbased p1blocking splint is fashioned holding the mp joints of the injured.
Epidemiology incidence most common injuries to the skeletal system. Injuries can occur at the proximal, middle, or distal phalanx. Anatomy of the middle phalanges surfaces and joints of a middle phalanx. Holding your finger a fixed position in a splint for 28 weeks is a common way to prevent further discomfort or injury. The fractures of the long and ring fingers are seen to be completely healed radiographically more than one year after the injury. Be wary of avulsion fracture of base of phalanx lateral or medial fracture fragment collateral ligament avulsion. Common finger fractures and dislocations american family. The interphalangeal ip traction system inserts a kwire at the proximal and distal phalanx. Extraarticular fractures of the middle phalanx with no. Proximal phalanx fractures prove to be clinically challenging in the same mechanical and anatomical manner as do middle phalanx fractures. Interphalangeal traction for comminuted fracture of middle. The mechanism of injury with middle phalanx fractures is usually a direct blow or crush. Antegrade jointsparing intramedullary wiring for middle.
Middle phalanx fracture radiology reference article. An understanding of the anatomy, the potential for joint instability, and the treatment options is essential to management of these fractures. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Finger fracture nondisplaced the student health provider has diagnosed a fracture break of your finger. The proximal interphalangeal pip joint and the distal interphalangeal dip joint form the articulations of the middle phalanx figure 1 and figure 2. Middle phalangeal fractures proximal to the fds insertion have an apex dorsal angulation, whereas fractures distal to the fds insertion have an apex volar angulation as shown in the figure.
A transverse fracture of the proximal phalanx of characteristic type, unstable and requiring plaster immobilibation after reduction. Conservative treatment of intraarticular middle phalanx fractures can lead to satisfying bone consolidation while permanent fracture reduction is not guaranteed, and periarticular adhesions are unavoidable. Principles of metacarpal and phalangeal fracture management. Pathology phalanx fractures can be intra or extraarticular and can oc. Regardless of treatment no fixation method is superior counsel patients prior to definitive. Proximal phalangeal fractures may be caused by an axial load, collateral ligament avulsion, or phys eal injury. Regardless of treatment no fixation method is superior counsel patients prior to definitive treatment to help set realistic expectations 48. Open fractures require immediate iv antibiotics and urgent surgical washout neurovascular compromise from fracture requires emergent reduction andor orthopedic intervention consider risk for compartment syndrome. Operative treatment of metacarpal and phalangeal shaft.
We present the results of 26 patients with 31 consecutive displaced or unstable extraarticular fractures of the base and shaft of the proximal and middle phalanges of the digits of the hand, treated over a period of 12 months with an intramedullary. The middle phalanx is injured with an axial force, parallel to the shaft. Pt notes driving to the goal when his shot was blocked as the ball was leaving his hand. Management of proximal phalangeal fractures of the hand using finger nail traction and a digital splint. Evaluation and management of toe fractures american. Pdf management of proximal phalangeal fractures of the hand. The proximal phalanx is less protected than the other phalanges, and it is exposed to a variety of forces, which produce varying fracture patterns. He noted swelling of the digit and ecchymosis under the finger nail. This article addresses current approaches for the rehabilitation of distal phalanx and middle phalanx fractures, excluding proximal interphalangeal joint avulsion fractures. The aim of this study is to test our hypothesis that type i fractures may be subclassified into following 2 types. For fractures of the middle phalanx, if conservative treatment is not sufficient, then percutaneous pinning or open reduction using kwires is used. Open fractures require immediate iv antibiotics and urgent surgical washout. Hardy, pt, ms, cht1 patients with common hand fractures are likely to present in a wide variety of outpatient. Fractures of the proximal and middle phalanges of the fingers.
Finger distal phalanx fracture hand surgery source. Fractures of the thumb bones fractures of phalanx a extra articular b intra articular extra articular1distalp longitudnal,transervse,tuft treatmentrepair of dermal nail matrix, application of splint,crif with k wire, orif with k wire dr sumer yadav, mch plastic surgery. Extend the splint to p2 for distal or unstable fractures. The deforming forces that act on the middle phalanx fractures are the fds and the intrinsic tendons. Because it is the longest of the toe bones, it is the most likely to fracture. Phalanx fractures are common injuries, although less common than metacarpal fractures. Metacarpal or phalanx orif open reduction and internal. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Buddy taping of a fractured phalanx to an adjacent, uninjured toe is a common and effective remedy. Fractures of the base of the middle phalanx have been classi.
Undisplaced metaphyseal and articular fractures may also be treated nonoperatively. Manual compression is applied across the fracture site during wire insertion. Phalangeal hand fracture musculoskeletal medicine for. Classifications of the fractures of the middle phalanx. Phalanx fracture middle georgia orthopaedics, warner robins, ga.
Many fractures can be treated without an operation. The proximal phalanx pp of the fingers is fractured more frequently than the middle or even distal phalanges. The restoration of the length and axis of the phalanx, such as the anatomic reduction of the articular surface in case of intraarticular association are basic principles that have to be followed. A fracture may also result if you accidentally hit the side of your foot on a piece of furniture on the groundand your toes are twisted or pulled sideways or in an awkward direction. The cause phalangeal fractures of the hand are usually the result of a direct trauma, crush or. Proximal interphalangeal pip joints between the middle and proximal phalanges in each finger 6 the base of each middle phalanx has two concave facets, with a smooth ridge separating them, for articulating with the head of the proximal phalanx 7. The ligamentotaxor allows immediate postoperative exercising throughout the bone healing period. Considerations tip crushtuft, distal phalanx minimal therapy required sensitivity, nail deformity, dipjt stiffness seymours fracture development of mallet injury, swan neck proximal phalanx adhesions angulation, rotation, growth plate problems pipjt oedema and reduced flexion metacarpal.
These tendons may avulse small fragments of bone from the phalanges. Left proximal phalanx 31% was the most frequently injured part. Malunion and nonunion of the metacarpals and phalanges. Patients should address specific medical concerns with their physicians. Many distal phalanx fractures are associated with crush injuries. Rehabilitation approaches for distal and middle phalanx. Significant softtissue crush is diagnosed clinically by the presence of severe swelling. The distal phalangeal diaphysis generally fractures. A number of fingers with fractures have had primary amputation because of ischaemia, they also have been excluded. Closed proximal phalangeal fracture management in hand. In fact, its the most common bone to break in your whole body, and it represents almost 10% of all broken bones.
Intraarticular injuries may lead to joint subluxation or dislocation. A simple and cheap device consisting of two kirschner wires and a nylon suture can. Type ib fractures are hypothesized to have a worse outcome. Pdf intramedullary headless screw fixation for fractures of. Discuss important neurovascular considerations blood supply etc. For the vast majority of phalanx fractures, an acceptable reduction is manageable. Fractures of the proximal interphalangeal joint constitute a broad spectrum of injuries. Fractures of metacarpals and phalanges are the most common fractures of the upper extremity. Phalanx fractures typically occur by crush injury, hyperextension, or direct axial force eg, stubbing the toe. Severely comminuted fractures of the middle phalanx of the digits are known to be demanding cases for hand surgeons. Treatment of intraarticular middle phalanx fractures using. These are usually the result of sports injuries in the young and accidental falls in the elderly. They can also result from the overuse and repetitive stress that comes with participating in highimpact sports like running and basketball.
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