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Review
. 2018 Jul;13(4):376-383.
doi: 10.1177/1558944717735947. Epub 2017 Oct 27.

Proximal Phalanx Fracture Management

Tim T Lögters  1 , Hannah H Lee  2 , Sebastian Gehrmann  1 , Joachim Windolf  1 , Robert A Kaufmann  2
Affiliations
Review

Proximal Phalanx Fracture Management

Tim T Lögters et al. Hand (N Y). 2018 Jul.

Abstract

Background: The goal of proximal phalangeal fracture management is to allow for fracture healing to occur in acceptable alignment while maintaining gliding motion of the extensor and flexor tendons.

Methods: We reviewed the most current literature on various treatment methods of proximal phalanx fractures, focusing on the indications and outcomes of nonoperative as well as operative interventions.

Results: Stable fractures can be successfully treated nonoperatively, whereas unstable injuries benefit from surgery. Regardless of the surgical intervention employed, the overriding goal is to restore anatomy and impart enough stability to allow for early motion. The surgical dissection contributes to soft tissue scarring and should be minimized.

Conclusions: Clinical success is achieved when acceptable fracture alignment and stability occur in the setting of unobstructed tendon gliding and early active range of motion.

Keywords: K-wire; fracture; phalanx; plate; screw; stability.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Kirschner wire (K-wire) fixation methods for proximal phalanx fracture. (a) Transarticular technique where the K-wire crosses the metacarpophalangeal joint prior to crossing the fracture site. (b) Periarticular technique where the pins start radial and ulnar from the base of the proximal phalanx and cross the fracture site.
Figure 2.
Figure 2.
Intra-articular technique of intramedullary compression screw fixation of proximal phalanx fracture. (a) The guidewire is placed through the metacarpophalangeal joint but not through the metacarpal head. (b) After guidewire insertion, a cannulated headless compression screw is driven over the guidewire until the screw head is buried.
Figure 3.
Figure 3.
Radial or ulnar midaxial plate placement for proximal phalanx fractures. (a) Extensor mechanism is retracted to gain fracture visualization, instead of being split iatrogenically. (b) Radial or ulnar midaxial placement of the plate avoids tendon being in direct contact and subsequent adherence to the plate.
Figure 4.
Figure 4.
Distal third proximal phalanx fracture with intra-articular extension requires reduction efforts with internal fixation, such as screws.
See this image and copyright information in PMC

References

    1. Al-Qattan MM. Displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers in industrial workers: reduction and K-wire fixation leaving the metacarpophalangeal and proximal interphalangeal joints free. J Hand Surg Eur Vol. 2011;36(7):577-583. - PubMed
    1. Basar H, Basar B, Basci O, et al. Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with mini plate plus screw or screw only. Arch Orthop Trauma Surg. 2015;135(4):499-504. - PubMed
    1. Belsky MR, Eaton RG, Lane LB. Closed reduction and internal fixation of proximal phalangeal fractures. J Hand Surg Am. 1984;9(5):725-729. - PubMed
    1. Black DM, Mann RJ, Constine RM, et al. The stability of internal fixation in the proximal phalanx. J Hand Surg Am. 1986;11(5):672-677. - PubMed
    1. Blaine TA, Rosier RN, Puzas JE, et al. Increased levels of tumor necrosis factor-alpha and interleukin-6 protein and messenger RNA in human peripheral blood monocytes due to titanium particles. J Bone Joint Surg Am. 1996;78(8):1181-1192. - PubMed

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