An Evidence-Based Guide for Managing Phalangeal Fractures

Abstract

halangeal fractures make up a quarter of hand and forearm fractures and are the second most common fracture of the upper extremity after distal radius and ulna fractures. 1,2 The highest incidence (21 percent) of phalangeal fractures occur in children aged 5 to 14 years and, overall, they are the most prevalent type of fracture in male patients. The most common mechanism of injury among pediatric patients is a crush injury during sport, whereas among adult patients, work-related injuries are the most common. 3 The distal phalanx is the most commonly fractured phalanx.Fractures of the phalanges are described according to the anatomical location (i.e., proximal, middle, or distal), fracture pattern (i.e., transverse, oblique, spiral, comminuted, or impacted), degree of displacement (i.e., none, minimal, or displaced), and articular involvement (i.e., none, unicondylar, or bicondylar). The initial workup of such fractures should involve three-view radiographs of the hand and dedicated radiographic views of the injured finger if needed. The decision for additional imaging modalities such as magnetic resonance imaging or ultrasound (for soft-tissue injury) or computed tomographic scan (for occult bony fractures) should be made based on clinical suspicion for concomitant injuries.These fracture characteristics are considered with associated injuries (e.g., open wounds, nail bed injuries, other fracture sites) and amount of soft-tissue loss to determine fracture stability and guide treatment strategies. Treatment options for phalangeal fractures encompass splinting or buddy taping with or without closed reduction, and operative treatment by percutaneous and open techniques. Operative indications for phalangeal fractures are listed in Table 1.This article will use a case-based approach to describe the steps involved in evaluating a phalangeal fracture and use an evidence-based approach to develop a treatment strategy. The principles in workup and treatment for each fractured digit are applicable to other digits sustaining similar fracture patterns. DISTAL PHALANX TUFT FRACTURE Representative CaseCase 1 An 11-year-old presents with a thumb crush injury involving a door. There is a subungual hematoma of

Phalangeal Fractures Requiring Vascular Reconstruction: Epidemiology and Factors Predictive of Reoperation

“…Other characteristics of fractures—such as articular involvement, dislocation of the fractured phalanx, and the presence of comminution—affect fracture stability, which typically dictates treatment for phalangeal fractures, particularly regarding the decision for operative management. 3,4…”

“…Other characteristics of fractures-such as articular involvement, dislocation of the fractured phalanx, and the presence of comminution-affect fracture stability, which typically dictates treatment for phalangeal fractures, particularly regarding the decision for operative management. 3,4 Traumatic injuries leading to fracture of the phalanges may also cause vascular compromise with acute ischemia of the affected digit, even in cases without traumatic amputation of the digit. These injuries require surgical intervention to restore perfusion to the dysvascular digit and attempt to minimize complications such as poor bone healing.…”

Multiple drill hole osteotomy and Herbert screw for correcting a-2 years ring finger phalanx media malunion: A case report

“…An inadequate treatment of phalanx fracture in which frequent fracture of the hand, may result in stiffness of the finger, loss in the range of motion, cosmetic problems, and disturbing the daily activity caused by scissoring deformity and creating the uncomfortable sensation while flexing the finger [1] , [2] . The long-term effects of the deformity can upset muscle balance, range from the weakness of pinch and grip, and may cause pain [3] .…”