Introduction Common hand injuries that can be broken into the following injuries proximal phalanx middle phalanx distal phalanx Epidemiology incidence most common injuries to the skeletal system account for 10% of all fractures distal phalanx is most common fractured bone in the hand Pathophysiology mechanism depends on age 10-29 years of age: sports is most common 40-69 year of age: machinery is most common >70 year of age: falls are most common pathoanatomy proximal phalanx fx deformity is usually apex volar angulation due to proximal fragment in flexion (from interossei) distal fragment in extension (from central slip) middle phalanx deformity is usually apex dorsal OR volar angulation apex dorsal if fracture proximal to FDS insertion (from extension of proximal fragment through pull of the central slip) apex volar if fracture distal to FDS insertion (prolonged insertion from just distal to the flare at the base to within a few mm of the neck) a fracture through the middle third may angulate in either direction or not at all secondary to the inherent stability provided by an intact and prolonged FDS insertion Associated conditions nail bed injuries associated with distal phalanx fractures Presentation Symptoms pain Physical exam local tenderness deformity look carefully for open wounds Imaging Radiographs finger xrays must get true lateral of joint hand xrays to rule out associated fractures 30°pronated lateral to see 4th and 5th CMC x/dislocation 30°supinated view to see 2nd and 3rd CMC fx/dislocation Treatment - Proximal Phalanx Fracture Nonoperative buddy taping indications extraarticular with < 10° angulation or < 2mm shortening and no rotational deformity 3 weeks of immobilization followed by aggressive motion reduction and splinting indications most distal phalanx fx Operative CRPP vs. ORIF indications irreducible or unstable fracture pattern transverse fractures (all angulate volarly) with > 10° angulation or 2mm shortening or rotationally deformed long oblique proximal phalanx fractures techniques crossed k-wires Eaton-Belsky pinning through metacarpal head minifragment fixation with plate and lag screws, or lag screws alone lag screws alone indicated in presence of long oblique fracture Treatment - Middle Phalanx Fracture Nonoperative buddy taping indications extraarticular with < 10° angulation or < 2mm shortening and no rotational deformity technique 3 weeks of immobilization followed by aggressive motion Operative CRPP vs. ORIF indications irreducible or unstable fracture pattern transverse fractures with > 10° angulation or 2mm shortening or rotationally deformed techniques crossed k-wires collateral recess pinning minifragment fixation with plate and lag screws Treatment - Distal Phalanx Fracture Nonoperative reduction and splinting indications most cases nail matrix may be incarcerated in fx and block reduction Operative remove nail, repair nailbed, and replace nail to maintain epi fold indications when distal phalanx associated with a nailbed injury see nail bed injuries ORIF +/- bone grafting indications non-unions Complications Loss of motion most common complication predisposing factors include prolonged immobilization, associated joint injury, and extensive surgical dissection treat with rehab, and surgical release as a last resort Malunion malrotation, angulation, shortening surgery indicated when associated with functional impairment corrective osteotomy at malunion site (preferred) metacarpal osteotomy (limited degree of correction) Nonunion uncommon most are atrophic and associated with bone loss or neurovascular compromise surgical options resection, bone grafting, plating ray amputation or fusion
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.49) A 34-year-old male sustains the closed finger injury shown in Figure A one week ago. He undergoes closed reduction and pinning shown in Figure B to correct alignment. Which of the following is responsible for the apex palmar fracture deformity noted on the preoperative radiographs? Review Topic QID: 4409 FIGURES: A B 1 Indirect pull of the central slip on the distal fragment and the interossei insertions at the base of the proximal phalanx 82% (3759/4582) 2 Intrinsic muscle fibrosis and intrinsic minus contracture 1% (58/4582) 3 PIP joint volar plate attenuation and extensor tendon disruption 2% (75/4582) 4 Rupture of the central slip with attenuation of the triangular ligament and palmar migration of the lateral bands 9% (403/4582) 5 Flexor tendon disruption with associated overpull of the extensor mechanism 5% (240/4582) Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ12.89) What is the optimal treatment for the proximal phalanx fracture shown in Figure A? Review Topic QID: 4449 FIGURES: A 1 Open reduction and placement of two 0.045-inch K-wires placed longitudinally through the metacarpal head 3% (117/3875) 2 Application of a 1.5-mm straight plate applied dorsally through and extensor tendon splitting approach 4% (167/3875) 3 Open reduction and lag screw fixation with 1.3mm screws through a radial approach 86% (3342/3875) 4 Placement of a 1.5-mm condylar blade plate through a radial approach 2% (78/3875) 5 Open reduction and retrograde passage of two 0.045-inch K-wires retrograde trough the PIP joint 4% (139/3875) Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
Fracture of the base of proximal phalanx of 5th finger (C101031) Hand - Phalanx Fractures HPI - Twisting injury to the hand How would you manage this fracture? 1/20/2018 196 3 6 Proximal phalanx fracture in a 20M (C2737) Hand - Phalanx Fractures HPI - 20 year old male presents with finger pain after a fall on outstretched hand. Closed injury. XRays are shown. Is the current position of the fracture acceptable? 12/2/2016 691 4 2 Nonunion of open extra-articular middle phalanx shaft fx (C2477) Hand - Phalanx Fractures HPI - 1st surgery 3 Months ago open fracture middle phalanx index finger treated with a mini plate. It resulted in skin necrosis and non union. 2nd surgery reverse cross finger flap and K wire fixation. How would you have treated this OPEN middle phalanx fracture on INITIAL presentation (see preoperative images above)? 1/6/2016 543 5 5 See More See Less