Phalanx fractures and dislocations in athletes

Abstract

Purpose of review: Phalangeal fractures, dislocations, and fracture-dislocations in the hand are common injuries. We review the current literature on the diagnosis and treatment of these injuries in the athlete. An understanding of the anatomy and its relationship to the mechanism of injury may help to direct appropriate management. Return to play remains an important concern to the patient-athlete.

Recent findings: Findings from recently published articles reinforce previously established treatment methods in the management of finger phalangeal fractures, dislocations, and fracture-dislocations. The majority of these injuries can be treated non-operatively. Technological advances in implant designs may conceivably allow for earlier rehabilitation and, in turn, a more expeditious return to sport. Management of phalangeal injuries in the elite athlete often necessitates special treatment considerations. The majority of phalangeal bone and joint injuries in the athlete can be treated in a comparable manner to the non-athlete. The goals of treatment are restoration of bone and joint alignment and stability in order to hasten a return to competition. Surgery as a means to expedite return to play in the high-level athlete should be determined on a case by case basis. Technological improvements in surgical implants may enable accelerated postoperative recovery. However, to our knowledge, there are no published studies to definitively support this assumption.

Keywords: Finger dislocations; Finger fracture-dislocations; Hand fractures; Phalangeal fractures; Sports injuries.

Fig. 1

a Intraoperative photograph of a double row non-locking plate used to stabilize a comminuted proximal phalanx fracture. b Intraoperative fluoroscopy image of the repaired fracture

Fig. 2

a Displaced, unicondylar fracture of the middle phalanx. b Intraoperative fluoroscopic image of the fracture reduced and stabilized with two cortical screws

Fig. 3

a Radiographic image of an irreparable dorsal fracture-dislocation of the proximal interphalangeal joint. b Hemi-hamate autograft harvest from the ipsilateral wrist. c Provisional K-wire stabilization of the osteochondral graft into volar base of middle phalanx. d Fluoroscopic image of definitive cortical screw fixation of the osteochondral graft

Fig. 4

a Late recognition of a now symptomatic proximal interphalangeal joint fracture in the small finger of a professional soccer goalie. b Fusion of the proximal interphalangeal joint in approximately 30° of flexion