Imaging plays an important role in diagnosis and in directing management of these injuries. A variety of splinting devices can be used for loose protection. Fractures of the distal phalanx are the most common fractures that occur in the hand. In general, of the many combinations of internal fixation possible, kirschner wires and screwandplate fixation predominate.
Two cases are presented that illustrate several unique features of this rare injury which have not been reported before. Evidence based rehabilitation methods for best outcomes in phalanx fractures will be outlined includi live webinar. Pt notes driving to the goal when his shot was blocked as the ball was leaving his hand. General treatment principles of phalangeal fractures. Other causes are low bone density and osteoporosis, which cause weakening of the bones. A method of qualifying this is lack of discomfort when direct manual. Fractures of the middle phalanx are relatively uncommon. Anatomy of special importance to middle phalanx fractures is described below. Principles of metacarpal and phalangeal fracture management jospt. Fabrication of a protective orthosis for the distal phalanx, pipj free 6. Wound caredressing changeskwire pin care as indicated 6, 7. Phalanx fracture finger hand free 30day trial scribd. Fractures of the proximal phalanx and metacarpals in the hand.
Splints are frequently discontinued after 6 weeks if pain free. Inherently stable fractures do not require surgical treatment. 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. After reduction of the proximal phalanx, an axial guidewire was introduced into the medullary canal as dorsally as possible. Phalanx fracture free download as powerpoint presentation. Unfortunately, hand injuries are very common and finger and hand injuries are the most common type of work related injury in australia. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function.
Distal tuft and phalanx fractures injuries figure 443 a. Finger fractures are among the most common fractures managed by primary care and emergency clinicians. Early closed reduction typically is successful for unicondylar fractures of the head of the proximal phalanx. Fracture of the distal phalanx is a wellknown orthopaedic condition in cattle that usually results from severe trauma to the sole of the digit blowey 2008. A simple and cheap device consisting of two kirschner wires and a nylon suture can. Foot fractures david bica, do, brown university alpert medical school, pawtucket, rhode island ryan a. If the broken bone punctures the skin, it is called an open or compound fracture. A phalanx fracture is a crack or complete break in one of these bones. In most cases the fixator was applied in the first week following fracture, the longest interval from injury to application being 21 days. They often result from direct trauma to the finger e. The p3 tuft fractures, and the middle phalanx base fractures each accounted f% fracture types. The universal goal in treating all fractures for the patient to achieve normal motion, but the ideal technique for stabilization is still debated. Fracture of the extensor process of the distal phalanx in. Phalanx fractures can be intra or extraarticular and can occur at the base, neck, shaft or head of the phalanx.
Treatment of extraarticular proximal and middle phalangeal. Operative treatment of metacarpal and phalangeal shaft fractures. Relationship between stress fractures of the proximal phalanx of the great toe and hallux valgus. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. The splinter series is back with its fourth installment. The best indications for lag screw fixation of the proximal phalanx include. Displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers in industrial workers. Evidence based rehabilitation methods for best outcomes in phalanx fractures will be outlined includi recorded webinar. Fahmy 1990 reported the use of the squattro in 20 cases of intraarticular phalangeal fractures. Gerring edgehill, little badminton lane,lea, malmesbury, wiltshire sn16 9ng, uk. Evaluation and management of toe fractures american. Minimally invasive finger fracture management american.
The flexor and extensor tendons impart a longitudinal compression force, which. Novel wire external fixation technique for proximal phalanx. A transverse fracture of the proximal phalanx of characteristic type, unstable and. Greg hritcko, pamela brant, in hand and upper extremity rehabilitation fourth edition, 2016. Interosseus muscles and lumbricals insert onto the base of the proximal phalanx and flex the proximal fragment. A total of %of fractures were treated conservatively, and %required surgery, with kirschner wir%the preferred surgical treatment. Alejandro badia thumb surgeon miami badia hand to shoulder center, doral fl finger hospital covid19 frequently asked questions search. Unusual stress fractures of the proximal phalanx of the great. Crush injuries to the distal phalanx are also common and can result in nail trauma and open fractures. The normal mp joint is a diarthrodial, condylar type joint. Dec 15, 2015 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. Epidemiology and treatment of phalangeal fractures. Distal phalangeal fractures must be examined for the presence of a nail bed laceration.
The flexor digitorum superficialis undergoes a second 90degree rotation, inserting into a ridge along the middle two thirds of the volar surface of the middle phalanx. In the closed crush fracture of the distal phalanx, the l shaped alumafoam splint placed on the volar aspect to protect the soft. The fracture is generally well seen on plain radiographs, angulation of these fractures is best seen on the lateral projection 2. We present 2 examples of comminuted base of proximal phalanx fractures were treated successfully using the distraction external fixation with excellent outcomes. This second edition textbook of minor emergencies is published by mosby division of elsevier features. We have been treating pilontype fractures about the metacarpophalangeal joint using a novel external fixation technique with success. Distal phalanx fracture radiology reference article. The surgical technique for closed intramedullary pinning of metacarpal and phalanx fractures is described. Fractures at the base of the distal phalanx are usually mallet avulsion fractures and are caused by rupture of the extensor tendon at the dip joint.
Ultrasonography can be used for fractures that are difficult to see or when there are doubts. Metacarpal and phalangeal fractures anatomical considerations. Fracture of the extensor process of the distal phalanx in a. Introduction metacarpal and phalangeal fractures are common upper limb fractures due to direct blows, axial loading, and torsional loading injuries. Scribd is the worlds largest social reading and publishing site. Proximal phalanx fractures prove to be clinically challenging in the same mechanical and anatomic manner as do middle phalanx fractures. The goal of proximal phalangeal fracture management is to allow for. Minimally invasive surgical treatment for unstable. Operative treatment of metacarpal and phalangeal shaft.
Certain distal phalangeal fractures, however, require opera tive treatment, such as. Percutaneous pinning of middle phalangeal neck fractures. Although the reported incidence in the literature is sparse, studies by roberts and others1, 2, 3 suggest that only 10% of all phalangeal fractures are located in the middle phalanx. One of the cases went on to nonunion, requiring bone grafting and internal fixation. Nondisplaced phalanx fractures are managed with splint immobilization. Dip extension splint used for distal finger injuries for protection and support percutaneous pinning at distal finger dip hyperextension splint mallet fingers ulnarradial gutter splint used for fractures of the hand. Between january 2011 and september 2014, a prospective study was conducted on 41 patients 48 fingers with unstable extraarticular fractures of the. Digits free splint if compliant older child with wrist and thumb ipjt free. A cohort of 32 patients with displaced fractures of a proximal phalanx was treated and assessed retrospectively after a short term 9 weeks after splint application. Middle phalanx fractures are the least common of the phalanx fractures.
Middle phalanx fracture radiology reference article. Minimally invasive fixation of fractures of the phalanges. Diagnosis may not be easy in the days immediately after fracture. In the royal infirmary, edin burgh, over the last four years we have had an opportunity of following. Pdf management of phalangeal fractures of hand researchgate.
Sprouse, md, west virginia university school of medicineeastern division, harpers ferry. Fractures of the proximal phalanx and metacarpals in the. Toe and forefoot fractures often result from trauma or direct injury to the bone. Optimal hand function is essential for good quality of life.
Fractures of the thumb bones fractures of phalanxa 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. An understanding of basic finger anatomy and common injury patterns provides the basis for diagnosing and treating these injuries. 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. Jul 11, 2016 traumatic finger injuries account for a substantial number of emergency visits every year. Displaced spiral fractures generally display shortening or rotation, whereas displaced transverse fractures may display angulation. In this post, we summarize some of the most commonly deployed splints in the ed. Perform gentle range of motion activities of the fingers. Jan 18, 2018 fractures at the base of the distal phalanx are usually mallet avulsion fractures and are caused by rupture of the extensor tendon at the dip joint. Overuse can cause stress fractures, which are very. A distal phalanx fracture is a disruption of the mechanical integrity of the distal phalanx. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Jun 12, 2018 this course will examine biomechanical and anatomical factors which impact choice in initial conservative or surgical intervention for phalanx fractures. The proximal interphalangeal pip joint and the distal interphalangeal dip joint form the articulations of the middle phalanx figure 1 and figure 2.
We report our experience with an isometric traction splint, modified from the southampton design. Proximal phalanx fracture radiology reference article. Phalanx fractures can occur at the base, neck, shaft or head of the phalanx. Pdf treatment of phalangeal and metacarpal fractures. Adams outline of fractures pdf free download ebook download.
The distal phalanx is the most common location for a nonphyseal injury which typically involves a crushing mechanism, and the most common location for physeal injury is the proximal phalanx. Tr eatment of phalangeal and metacarpal fractures 43 pb journal of orthopaedics v olx, no. Distal phalanx fractures are among the most common fractures in the hand they represent 50% of all phalangeal fractures and frequently involve the ungual tuft 1 they are frequently related to sports, with lesions such as the mallet finger and the jersey finger. Closed intramedullary pinning of metacarpal and phalanx fractures. Fractures of the phalanx and metacarpals are some of the most frequently encountered orthopedics injuries and constitute between 1428% of all visits to emergency department which. Videos of acute and chronic mallet fractures, distal phalanx fractures with nail injuries, and early protected.
Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction. Fractures of metacarpals and phalanges are the most common fractures of the upper extremity. James university of edinburgh fractures of the proximal and middle phalanges of the fingers pre sent difficult and unsolved problems. Proximal phalanx fractures often present with apex volar angulation. Metacarpal or phalanx orif open reduction and internal fixation. Hard walking surfaces, oestrous behaviour, service, transportation, heavy bodyweight, hoof overgrowth, and weakened bone due to age or fluorosis may be predisposing factors for the disease greenough and others 1981, blowey 2008. A phalanx fracture can happen when your finger or toe is hit, pulled, jammed, crushed, or twisted. Finger distal phalanx fracture hand surgery source. Finger distal phalanx fractures including mallet finger fracture, fdp tendon avulsion fracture and dip joint volar plate avulsion fracture. Fracturedislocations are possible when the fracture. Tuft fractures are treated by caring for the accompanying softtissue injury and splinting of the finger to prevent further discomfort or injury. The goal of proximal phalangeal fracture management is to allow for fracture healing to occur in acceptable alignment while.
The most common problem following phalanx fractures is stiffness, and the best means to prevent this is early protected motion. Fractures of the proximal phalanx hand and finger orthopedic dr. Fractures of the proximal and middle phalanges of the fingers. Nov 17, 2016 the most common phalanx fractures involve the border digits, namely, the index and small finger rays fig. Severely comminuted fractures of the middle phalanx of the digits are known to be demanding cases for hand surgeons. The proximal phalanx is less protected than the other phalanges and is exposed to a variety of forces. 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 wide array of treatment options exists for the variation in fracture patterns observed. Fractures of the proximal phalanx hand and finger orthopedic.
The proximal phalanx is the toe bone that is closest to the metatarsals. The joint is stabilized by collateral ligaments which originate on the dorsal aspect of the metacarpal head neck junction and insert on the volar aspect of the proximal phalanx. Fractures commonly happen because of car accidents, falls, or sports injuries. Pdf outline of fractures ebooks download open reduction and lag screw fixation through a radial approach is the treatment of choice for long oblique proximal phalanx fractures pdf outline of fractures.
Fractures and ligament injuries occupational therapy department. It is also possible for a tumor or cyst to weaken the bone, causing it to break easily when injured. Splinters to fractures, 2nd edition is edited by philip buttaravoli. Fractures of the third phalanx often present difficult problems for the clinician. Fractures can also develop after repetitive activity, rather than a single injury. Classifications of the fractures of the middle phalanx. Radiographic features these fractures are generally well visualized on plain radiographs. Splinting common static splints tip protector splint used for distal finger injuries for protection and support. Middle and proximal phalanx fractures may be caused by a twisting force that may produce a spiral. For internal fixation, kirschner wires kwires or miniplates can be used, and each carries certain.
Successful rehabilitation of hand fractures addresses the need to 1 maintain. Oct 06, 2016 mallet finger injury no splint treatment by hand exercises. During this time the fingers are free and encouraged to move. He noted swelling of the digit and ecchymosis under the finger nail. See page 308 for corresponding case report fractures of the third phalanx e. The mechanism of injury usually results from a direct blow to the tip of the finger that causes forced flexion of the dip joint. Proximal phalanx fractures are the most common pediatric hand fracture 1. Request pdf proximal phalanx fracture management background. This course will examine biomechanical and anatomical factors which impact choice in initial conservative or surgical intervention for phalanx fractures. Racgp hands, fingers, thumbs assessment and management. Closed reduction and internal fixation versus open.
Treatment of fractures of the proximal phalanx of the long fingers remains difficult and challenging. These are common injuries in basketball or baseball players. Minor emergencies 2nd edition ebook pdf free download edited by philip buttaravoli splinters to fractures published by mosby elsevier about the book. Reduction can be achieved by either closed manual techniques. Because it is the longest of the toe bones, it is the most likely to. Closed intramedullary pinning of metacarpal and phalanx. Phalanx fracture middle georgia orthopaedics, warner robins, ga. Treatment of fractures of the proximal phalanx of long. 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. For proximal phalanx fractures, a handbased p1blocking splint is fashioned holding the mp joints of the injured. Most reported fractures of the proximal phalanx of the great toe have been associated with halux valgus deformity. Principles of metacarpal and phalangeal fracture management.