Background: Despite the relatively high incidence of phalangeal fractures, there is an imperfect understanding of the epidemiology and anatomical distribution of these fractures. This study describes the patient characteristics, anatomic distribution, and detailed fracture patterns of phalangeal fractures among a large adult cohort in the United States. Methods: A retrospective study was performed among patients with phalangeal fractures in the United States between January 2010 and January 2015. Included patients were 18 years old or older and had a diagnosis of a phalangeal fracture. A total of 2140 phalangeal fractures in 1747 patients were included, and a manual chart review was performed to collect epidemiological and radiographic information. Fractures were classified based on location and fracture pattern. Results: The median age at the time of injury was 45 years (interquartile range, 30–57), and 65% of patients were men. The small finger had the highest incidence of fractures (26%) followed by the ring finger (24%). Distal and proximal phalanges demonstrated the highest incidence of fractures at 39% each. The dominant hand was affected in 44% of cases. Eighteen percent of fractures were due to a work-related trauma mechanism, and the most common mechanism of injury was blunt trauma (46%). Conclusion: This study provides a detailed overview of the anatomic distribution and fracture patterns of phalangeal fractures in an adult US population and, thus, may aid hand surgeons treating these injuries.

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Background: Lower extremity free flap failure rates are higher than in other areas of the body. While prior studies assessed the effect of intraoperative technical variables, these generally investigated individual variables and did not examine relationships between the many individual technical decisions made during a free tissue reconstruction. Purpose: Investigate the effect of variation in intraoperative microsurgical techniques on flap outcomes in a diverse cohort of patients requiring lower extremity free flap coverage. Methods: Consecutive patients undergoing free flap reconstruction of the lower extremity at two level 1 trauma centers from January 2002 to January 2020 were identified using CPT codes, followed by review of medical records. Demographics and comorbidities, indications, intraoperative technical details, and complications were collected. Outcomes of interest included unplanned return to the operating room, arterial thrombosis, venous thrombosis, partial flap failure, and total flap failure. Bivariate analysis was performed. Results: 410 patients underwent 420 free tissue transfers. Median follow up time was 17 months (IQR 8.0-37). Total flap failure occurred in 4.9% (n=20), partial flap failure in 5.9% (n=24), and unplanned reoperation in 9.0% (n=37), with arterial thrombosis in 3.2% (n=13), and venous thrombosis 5.4% (n=22). Overall complications were significantly associated with recipient artery choice, with arteries other than PT and AT/DP having a higher rate (p=0.033), and with arterial revisions (p=0.010). Total flap failure was also associated with revision of the arterial anastomosis (p=0.035), and partial flap failure was associated with recipient artery choice (p=0.032). Conclusions: Many interoperative options and techniques are available when performing microvascular lower extremity reconstruction that lead to equally high success rates. However, use of arterial inflow outside of the posterior tibial and anterior tibial arteries leads to a higher overall complication rate and partial flap failure rate. Intraoperative revision of the arterial anastomosis portends poorly for ultimate flap survival.