Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Phalangeal Fracture Surgery Workup

  • Author: Brian J Divelbiss, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Sep 28, 2015
 

Imaging Studies

Plain radiography is sufficient for the diagnosis of injuries to the phalanges. Oblique radiography may be helpful for injuries around the distal interphalangeal joint (DIPJ) and the proximal interphalangeal joint (PIPJ). Computed tomography (CT) and magnetic resonance imaging (MRI) do not play significant roles in the assessment of the acutely injured finger. (See the images below.)

Phalangeal fractures. Acute dorsal proximal interpPhalangeal fractures. Acute dorsal proximal interphalangeal joint (PIPJ) fracture-dislocation. Image courtesy of Mark Baratz, MD.
Phalangeal fractures. Treatment with dorsal blockiPhalangeal fractures. Treatment with dorsal blocking splint. Image courtesy of Mark Baratz, MD.
 
 
Contributor Information and Disclosures
Author

Brian J Divelbiss, MD Attending Staff, Dickson-Diveley Midwest Orthopedic Clinic, Inc, and Kansas City Orthopedic Institute; Associate Clinical Professor, Department of Orthopedic Surgery, University of Missouri-Kansas City

Brian J Divelbiss, MD is a member of the following medical societies: Alpha Omega Alpha, American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert J Nowinski, DO Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Ohio State Medical Association, Ohio Osteopathic Association, American College of Osteopathic Surgeons, American Osteopathic Association

Disclosure: Received grant/research funds from Tornier for other; Received honoraria from Tornier for speaking and teaching.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

References
  1. Baratz ME, Divelbiss B. Fixation of phalangeal fractures. Hand Clin. 1997 Nov. 13(4):541-55. [Medline].

  2. De Jonge JJ, Kingma J, van der Lei B, Klasen HJ. Phalangeal fractures of the hand. An analysis of gender and age-related incidence and aetiology. J Hand Surg [Br]. 1994 Apr. 19(2):168-70. [Medline].

  3. Gaston RG, Chadderdon C. Phalangeal fractures: displaced/nondisplaced. Hand Clin. 2012 Aug. 28(3):395-401, x. [Medline].

  4. Kömürcü M, Alemdaroglu B, Kürklü M, Ozkan H, Basbozkurt M. Handgun injuries with metacarpal and proximal phalangeal fractures: early definitive treatment. Int Orthop. 2008 Apr. 32(2):257-62. [Medline].

  5. Lubahn JD, Hood JM. Fractures of the distal interphalangeal joint. Clin Orthop. 1996 Jun. (327):12-20. [Medline].

  6. Lee JJ, Park HJ, Choi HG, Shin DH, Uhm KI. Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials. Arch Plast Surg. 2013 Jul. 40(4):397-402. [Medline]. [Full Text].

  7. Jehan S, Chandraprakasam T, Thambiraj S. Management of proximal phalangeal fractures of the hand using finger nail traction and a digital splint: a prospective study of 43 cases. Clin Orthop Surg. 2012 Jun. 4(2):156-62. [Medline]. [Full Text].

  8. Goorens CK, Van Hoonacker P, Kerckhove D, Berghs B, Goubau J. Treatment of fractures of the proximal phalanx of long fingers with an isometric traction splint. Acta Orthop Belg. 2012 Aug. 78(4):473-8. [Medline].

  9. Pehlivan O, Kiral A, Solakoglu C, et al. Tension band wiring of unstable transverse fractures of the proximal and middle phalanges of the hand. J Hand Surg [Br]. 2004 Apr. 29(2):130-4. [Medline].

  10. Gonzalez MH, Igram CM, Hall RF. Intramedullary nailing of proximal phalangeal fractures. J Hand Surg [Am]. 1995 Sep. 20(5):808-12. [Medline].

  11. Johnson D, Tiernan E, Richards AM, Cole RP. Dynamic external fixation for complex intraarticular phalangeal fractures. J Hand Surg [Br]. 2004 Feb. 29(1):76-81. [Medline].

  12. Metcalfe D, Aquilina AL, Hedley HM. Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis. J Hand Surg Eur Vol. 2015 Sep 1. [Medline].

  13. Wehbe MA, Schneider LH. Mallet fractures. J Bone Joint Surg [Am]. 1984 Jun. 66(5):658-69. [Medline].

  14. Pun WK, Chow SP, So YC, et al. Unstable phalangeal fractures: treatment by A.O. screw and plate fixation. J Hand Surg [Am]. 1991 Jan. 16(1):113-7. [Medline].

  15. Roth JJ, Auerbach DM. Fixation of hand fractures with bicortical screws. J Hand Surg [Am]. 2005 Jan. 30(1):151-3. [Medline].

  16. Weiss AP, Hastings H 2d. Distal unicondylar fractures of the proximal phalanx. J Hand Surg [Am]. 1993 Jul. 18(4):594-9. [Medline].

  17. Khalid M, Theivendran K, Cheema M, Rajaratnam V, Deshmukh SC. Biomechanical comparison of pull-out force of unicortical versus bicortical screws in proximal phalanges of the hand: A human cadaveric study. Clin Biomech (Bristol, Avon). 2008 Jul 21. [Medline].

  18. Tan JS, Foo AT, Chew WC, Teoh LC. Articularly placed interfragmentary screw fixation of difficult condylar fractures of the hand. J Hand Surg Am. 2011 Apr. 36(4):604-9. [Medline].

  19. Ouellette EA, Freeland AE. Use of the minicondylar plate in metacarpal and phalangeal fractures. Clin Orthop. 1996 Jun. (327):38-46. [Medline].

  20. Henry M. Soft tissue sleeve approach to open reduction and internal fixation of proximal phalangeal fractures. Tech Hand Up Extrem Surg. 2008 Sep. 12(3):161-5. [Medline].

  21. Freeland AE, Benoist LA, Melancon KP. Parallel miniature screw fixation of spiral and long oblique hand phalangeal fractures. Orthopedics. 1994 Feb. 17(2):199-200. [Medline].

  22. Matloub HS, Jensen PL, Sanger JR, et al. Spiral fracture fixation techniques. A biomechanical study. J Hand Surg [Br]. 1993 Aug. 18(4):515-9. [Medline].

  23. Williams RM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg [Am]. 2003 Sep. 28(5):856-65. [Medline].

  24. Bear DM, Weichbrodt MT, Huang C, Hagberg WC, Balk ML. Unstable dorsal proximal interphalangeal joint fracture-dislocations treated with extension-block pinning. Am J Orthop (Belle Mead NJ). 2015 Mar. 44 (3):122-6. [Medline].

  25. Capo JT, Hastings H 2nd, Choung E, Kinchelow T, Rossy W, Steinberg B. Hemicondylar hamate replacement arthroplasty for proximal interphalangeal joint fracture dislocations: an assessment of graft suitability. J Hand Surg [Am]. 2008 May-Jun. 33(5):733-9. [Medline].

  26. Schenck RR. Dynamic traction and early passive movement for fractures of the proximal interphalangeal joint. J Hand Surg [Am]. 1986 Nov. 11(6):850-8. [Medline].

  27. Stern PJ, Roman RJ, Kiefhaber TR, McDonough JJ. Pilon fractures of the proximal interphalangeal joint. J Hand Surg [Am]. 1991 Sep. 16(5):844-50. [Medline].

  28. van Oosterom FJ, Ettema AM, Mulder PG, Hovius SE. Impairment and disability after severe hand injuries with multiple phalangeal fractures. J Hand Surg [Am]. 2007 Jan. 32(1):91-5. [Medline].

  29. Creighton JJ Jr, Steichen JB. Complications in phalangeal and metacarpal fracture management. Results of extensor tenolysis. Hand Clin. 1994 Feb. 10(1):111-6. [Medline].

  30. Yamazaki H, Kato H, Uchiyama S, Ohmoto H, Minami A. Results of tenolysis for flexor tendon adhesion after phalangeal fracture. J Hand Surg Eur Vol. 2008 Jul 28. [Medline].

  31. Chim H, Teoh LC, Yong FC. Open reduction and interfragmentary screw fixation for symptomatic nonunion of distal phalangeal fractures. J Hand Surg Eur Vol. 2008 Feb. 33(1):71-6. [Medline].

  32. Hsu LP, Schwartz EG, Kalainov DM, Chen F, Makowiec RL. Complications of K-wire fixation in procedures involving the hand and wrist. J Hand Surg Am. 2011 Apr. 36(4):610-6. [Medline].

  33. Yong FC, Tan SH, Tow BP, Teoh LC. Trapezoid rotational bone graft osteotomy for metacarpal and phalangeal fracture malunion. J Hand Surg Eur Vol. 2007 Jun. 32(3):282-8. [Medline].

  34. Reyes BA, Ho CA. The High Risk of Infection With Delayed Treatment of Open Seymour Fractures: Salter-Harris I/II or Juxta-epiphyseal Fractures of the Distal Phalanx With Associated Nailbed Laceration. J Pediatr Orthop. 2015 Aug 28. [Medline].

  35. Freeland AE, Hardy MA, Singletary S. Rehabilitation for proximal phalangeal fractures. J Hand Ther. 2003 Apr-Jun. 16(2):129-42. [Medline].

Previous
Next
 
Phalangeal fractures. Acute dorsal proximal interphalangeal joint (PIPJ) fracture-dislocation. Image courtesy of Mark Baratz, MD.
Phalangeal fractures. Treatment with dorsal blocking splint. Image courtesy of Mark Baratz, MD.
Phalangeal fractures. Custom figure-of-eight splint used once motion is begun. Image courtesy of Mark Baratz, MD.
Phalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD.
Phalangeal fractures. Treatment with multiple minifragment screws plus Kirschner wires (K-wires). Image courtesy of Mark Baratz, MD.
Phalangeal fractures. Acute dorsal proximal interphalangeal joint (PIPJ) fracture-dislocation. A concentric reduction could not be maintained in a dorsal blocking splint. Image courtesy of Mark Baratz, MD.
Phalangeal fractures. Treatment with a dorsal blocking percutaneous pin. Image courtesy of Mark Baratz, MD.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.