1445 Portland Ave Suite 201
Rochester, NY 14621
Treatment of finger (phalangeal) fractures
April 24th, 2007
In general, fractures of the phalanges (proximal-P-1, middle-P-2, and distal-P-3) can be treated nonoperatively. If angulation, displacement or malrotation require reduction, I will often do this under local anesthesia--and at times provisionally stabilize the fracture with removeable pins.Occasionally, more rigid fixation is adviseable to allow early motion at the PIP joint. Interfragmentary screws, alone, are ideal since these diminish the risk of tendon adgerence and stiffness. Though the use of plates on the phalanges is associated with potential extensor tendon adherence, stiffness, and second-stage removal, they are needed occasionally--as depicted in Case 3 below.
I will discuss your particular fracture type with you as well as the basis for my recommendation regarding ideal treatment.
Related Photos:
Preoperative PA xray shows unstable proximal phalangeal fractures
Lateral xray shows angulation
K wires were used as an alternative to plates and screws, to minimize potential complications. Open incisions were still required
Postoperative lateral xray shows wire placement and correction of angulation
Excellent digital flexion 5 months later
Finger extension at 5 months
Case 2. Preoperative photo shows splay and malrotation of the 4th digit
Preoperative PA xray shows long spiral fracture of the proximal phalanx
Preoperative lateral xray
Interfragmentary screws obviated the need for a plate
Postoperative lateral xray
Digital flexion
Digital extension
Case 3. Preoperative PA xray shows severe displacement of the middle phalanx
Preoperative lateral xray
Intraoperative photo show plate
Postoperative PA xray after union
Postoperative lateral xray