apex volar angulation if distal to FDS insertion; apex dorsal angulation if proximal to … When evaluating a proximal phalanx fracture, it is important to pay attention to the tendon function of the involved digit, as the bottom of the flexor tendon sheath is constituted of the palmar aspect of the phalangeal bone.
Pediatric phalanx fractures: unique challenges and pitfalls. When using lag screws, maximal fracture compression is obtained. This position of function shifts the extensor aponeurosis distally to cover the majority of the proximal phalanx dorsally, which compresses and stabilizes the fracture. If coronal forces are applied to a finger, intra-articular avulsion fractures of the base of the proximal phalanx are a consequence of ligament strength superior to bone strength. Displaced fractures, that are unstable after closed reduction, require stable pin or percutaneous screw fixation. Proximal phalanx fractures can be epiphyseal or shaft fractures and can be intra-articular or extra-articular. Gustilo Anderson classification (compound fracture), longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, Roy-Camille classification (odontoid process fracture ), subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal.
Associated joint injury and soft tissue injury are contributing factors to reduced mobility of the fractured finger.4 When treating a combined fracture and tendon lesion, it is necessary to achieve absolute stability in the fixation of the fracture, to enable early active mobilization of the tendon injury. The fracture is generally well seen on plain radiographs, angulation of these fractures is best seen on the lateral projection 2. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers.
The AO Foundation divides the base fractures of the proximal phalanx into proximal metaphyseal and proximal articular.
In my practice “buddy taping” is always used if the fracture is non-displaced and stable, or displaced and stable after closed reduction allowing immediate mobilization ( Fig.
If reduction maintained, continue splint for 3–4 wks; if reduction fails, refer to ortho/hand for ORIF or percutaneous fixation. The use of plates and screws requires that a rigid osteosynthesis is obtained during surgery, as immediate mobilization is needed after open surgery to secure an acceptable function by avoiding adhesion of the soft tissues to the bone.6–8.
Surgical fixation involves Kirchner wires or very small screws. Digital nerve injury: Contusion, transection, Digital artery injury: Open or closed fracture; usually does not require treatment, Tendon injury: Complete or partial rupture; infrequent with proximal phalangeal fracture, Thumb avulsion fracture common with ulnar collateral ligament injury (skier's thumb), Mechanism of injury: Direct blow, axial load, axial traction, twisting/torque, or “grabbing a jersey”, History of previous injury, surgery, or deformity. A phalangeal fracture is the most common injury to the skeletal system and accounts for approximately 10% of all fractures. Operative carpal and hand injuries in children.
In medical lingo, a proximal phalanx is the bone in each toe closest to the metatarsal bone that connects to the intermediate phalanx bone. Displaced (> 2 mm) radial/ulnar avulsion or shearing fractures of the proximal metaphysis needs closed or open reduction and internal fixation, as joint stability may be compromised. Read More, 2nd most common phalangeal fracture in adults, Base of proximal phalanx fracture is most common pediatric hand injury. Evaluation of the soft tissues, nerves, and tendons of the injured finger is mandatory when the treatment method is to be determined.
When evaluating a proximal phalanx fracture, it is important to pay attention to the tendon function of the involved digit, as the bottom of the flexor tendon sheath is constituted of the palmar aspect of the phalangeal bone. Closed reduction and external fixation provides stabilization with minimal risk of worsening the soft tissue lesion caused by the trauma.
Fig. Nerve lesions are usually associated to open injuries. This deformity tends to be maintained by the intrinsic muscle insertion on the base of the proximal phalanx (dorsal interossei) and the extension force of the central slip across the proximal interphalangeal (PIP) joint (palmar interossei and lumbricals insertion into lateral bands of the extensor hood).
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