- See:
-
Characteristics of Phalangeal and Metacarpal Fracture:
-
Injury to the Phalanges:
- Discussion:
- important deforming force is the insertion of central slip
into the dorsum of the base of the middle phalanx & insertion
of flexor digitorum superficialis volarly;
- central slip has a well defined area of insertion, and its action
is to extend the middle phalanx;
- although action of
FDS is to flex middle phalanx, its insertion is
rather complex & is not confined to short segment of phalanx;
-
FDS has a prolonged insertion, extending from a point just distal to
flare of the base to a point only a few mm proximal to the neck;
- ie. they form a broad expanse of tendon beneath the profundus;
-
SH Type III Frx:
- Angulation:
- frx thru neck of middle phalanx is likely to have volar angulation, as
proximal fragment tends to be flexed by strong pull of superficialis;
- frx thru base of middle phalanx is more likely to be dorsally
angulated owing to extending force of central slip on proximal
fragment & flexing force on distal fragment by superficialis;
- frx thru middle 2/3 of bone may be angulated in either direction or
not at all; not always predicatable on basis of tendon insertion;
- typically proximal to the FDS insertion - angulate dorsally;
- typically distal to the FDS insertion - angulate volarly;
- Non Operative Treatment:
- Casting:
- w/ dorsal angulation at the frx site, consider holding injured digit
in slight flexion;
- Buddy Taping:
- encourages pt to move fingers, while the fracture heals;
- certain undisplaced fractures and impacted fractures of the
phalanges are ideally suited for buddy taping but only if
frx is truly stable (undisplaced with no angulation in
any plane - esp volar angulation);
- Operative Treatment:
-
condylar frx:
- middle phalanx dorsal base avulsion fractures:
- orif if 2 mm displaced or extension lag (boutonniere) will occur;
- may be associated w/
PIP dislocation
- shaft frx:
Operative treatment of intra-articular fractures of the dorsal aspect of
the distal phalanx of digits.
Treatment principles for proximal and middle phalangeal fractures.
Articular fractures of the digits: a prospective study.
A prospective study of 245 open digital fractures of the hand.
Role of antibiotics in open fractures of the finger.
