Anatomy of special importance to distal phalanx fractures is described below. Proximal phalanx fracture management rom initiated per doctors orders andor at 24 weeks with splint utilized up to 6 weeks. Operative treatment of metacarpal and phalangeal shaft fractures. This study was conducted in order to study the aetiology, features and management of the phalangeal fractures of hand. Characteristic deformity of proximal phalanx fractures volar angulation due to pull of interossei on proximal fragment and extensor pull on distal fragment results in pip jt flexion contracture due to functional lengthening of the interosseiextensors preventing full pip jt extension. These fractures are commonly caused by trauma or crush injuries.
These files will have pdf in brackets along with the filesize of the download. Fractures of the proximal phalanx can be complex owing to forces exerted on the fracture fragments by a number of muscles and tendons which often result in angular or rotational deformity. We treated 50 isolated fractures with closed reduction and percutaneous pinning using 1 of 2 techniques. S117 ao pediatric comprehensive classification of long bone fractures pccf. The fracture will cause severe pain and swelling in the finger. Fracturedislocations are possible when the fracture. Phalangeal fractures are approximately 10% of all the fractures of skeletal system. Evaluation and management of toe fractures american. Distal phalanx fracture pilon fracture of the finger scaphoid fractures scapholunate ligament tears perilunate dislocations acute traumatic carpal tunnel syndrome elbow overuse injuries. They have different prognosis and treatment depending on the location of the fracture. Minimally invasive finger fracture management american. The second through fifth toes have a proximal, middle and distal phalanx. These are common injuries in basketball or baseball players. Phalanx fracture free download as powerpoint presentation.
Fractures of the distal phalanx of the forelimb were diagnosed in 5 colts and 3 fillies ranging in age from 2 weeks to 5 12 months at the time of fracture. The outcomes literature on proximal phalanx fractures in children is sparse. Phalanx fractures are common injuries, although less common than metacarpal fractures. Some fractures have hidden pitfalls and need to be treated aggressively to prevent having an unacceptable outcome. For proximal phalanx fractures, a handbased p1blocking splint is fashioned holding the mp joints of. Fractures of the distal radius with volar displacement and angulation of the distal fragment greenspan 1992 618p. The diaphysial axismetacarpal head angle in the management of fractures at the base of the proximal phalanx in children. Leggit, ltc, mc, usa, general leonard wood army community hospital, fort. For the vast majority of phalanx fractures, an acceptable reduction is. Phalanx fractures splint can be hand based, with velcro to attach traction to underside of splint cover with plastic bag for shower need to keep dry to protect skin tape can be removed by once per week for hygiene traction on average 3. The fracture involved the fossa of the collateral ligament on the distal phalanx in.
Operative treatment of metacarpal and phalangeal shaft. Distal phalanx fractures represent common sports and workrelated injuries, accounting for approximately half of all hand fractures. The patient had actually realigned the two sections of the bone to allow healing. Conservative treatment of fractures of the proximal. Proximal phalanx fractures are often angulated at the time of presentation independent of mechanism as muscle forces deform the unstable shaft. If you do not have it you can download adobe reader free of charge. Jun 12, 2018 this course will examine biomechanical and anatomical factors which impact choice in initial conservative or surgical intervention for phalanx fractures. Percutaneous pinning of fractures in the proximal third of.
Aoota classification pdf ao surgery reference ao foundation. Jan 18, 2018 fractures at the base of the distal phalanx are usually mallet avulsion fractures and are caused by rupture of the extensor tendon at the dip joint. This course will examine biomechanical and anatomical factors which impact choice in initial conservative or surgical intervention for phalanx fractures. However, sometimes, to achieve the best possible outcome, it. Fractures and ligament injuries occupational therapy department the royal childrens hospital melbourne, 2014.
Fractures, dislocations, and thumb injuries jeffrey c. Many fractures can be treated without an operation. They often result from direct trauma to the finger e. A method of qualifying this is lack of discomfort when direct manual. This comprehensive system contains plates for fractures of the metacarpal neck, fractures of.
Case discussion open fracture of the middle phalange of the right middle finger. Holding your finger a fixed position in a splint for 28 weeks is a common way to prevent further discomfort or injury. Sometimes just taping the broken finger to the uninjured fingers next to it will be enough. A direct blow commonly causes proximal phalanx fractures but rotational forces and hyperextension can also cause injury. They can also result from the overuse and repetitive stress that comes with participating in highimpact sports like running and basketball.
The great toe has only a proximal and distal phalanx. Phalangeal hand fracture musculoskeletal medicine for. Extend the splint to p2 for distal or unstable fractures. Fractures at the base of the distal phalanx are usually mallet avulsion fractures and are caused by rupture of the extensor tendon at the dip joint.
Patients should address specific medical concerns with their physicians. The fractures were oriented in an axial proximal to abaxial distal and palmar to dorsal orientation and extended from the base of the ossi. Finger phalanx fracture reduction and pinning therapy protocol. Evidence based rehabilitation methods for best outcomes in phalanx fractures will be outlined including strategies to address potential complications. Surgical treatment is necessary when fracture is displaced and reduction is not possible. For proximal phalanx fractures, a handbased p1blocking splint is fashioned holding the mp joints of the injured. Treated differently to other fractures have their own protocol often associated with a dislocation injury therefore need to assess for other structural damage ie collateral ligaments and adjust treatment accordingly protected mobilisation indicated immediately post fracture. After 3 days, take the medicine only if you need it. Nhs trust physiotherapy department phalangeal fractures.
Toe and forefoot fractures can result from a direct blow to your footsuch as dropping a heavy object on your toes. Fractures of the base of the proximal phalanx surgical approach. Fracturesbroken bones data fractures, broken bonesyou can call it what you wish, it means the same thingare among the most common orthopedic problems, about 6. Minimally invasive fixation of fractures of the phalanges. The middle finger is most often affected, followed by the thumb. Phalanx fractures can be intra or extraarticular and can occur at the base, neck, shaft or head of the phalanx. Phalangeal fractures of the hand are a common injury that presents to the. If you break one of these bones you have a phalangeal fracture.
Transverse fracture with minimal or no comminution. The oblique views of the third phalanx d65pr45lpadimo and d65prmpadiloare used to evaluate the palmar processes of the third phalanx and the margins of the distal interphalangeal joint. Conservative treatment of fractures of the proximal phalanx. Keywords proximal phalanx, fracture, nonsurgical treatment. He noted swelling of the digit and ecchymosis under the finger nail. Racgp hands, fingers, thumbs assessment and management of. Phalangeal fractures are common injuries that can occur at the proximal, middle, or distal phalanx. Pseudoclawing skeletal shortening incompetent extensor tendon 8 middle phalanx fractures.
You will receive a prescription for narcotic pain medicine. The session protocol was 4 minutes over the fracture site with the loop coiled photo 9 plus 2 minutes over the upper thoracic spine in particular over the t1 area. Splinting common static splints tip protector splint used for distal finger injuries for protection and support. Family practice notebook 2020, family practice notebook, llc. Fractures of the distal phalanx and associated soft tissue. Alejandro badia thumb surgeon miami badia hand to shoulder center, doral fl finger hospital. Nondisplaced phalanx fractures are managed with splint immobilization. Nov 07, 2019 phalangeal fractures are common injuries that can occur at the proximal, middle, or distal phalanx.
Held m1, jordaan p, laubscher m, singer m, solomons m. Tuftdistal phalanx fracture common fracture smashing or crushing injury caught in jersey, bw helmets usually treated conservatively if kwire removed approx. For the first 23 days, take the pain medication around the clock to stay on top of the pain control. The flexor digitorum superficialis undergoes a second 90degree rotation, inserting into a ridge along the middle two thirds of the volar surface of the middle phalanx. Phalangeal fractures of the hand are usually the result of a direct trauma, crush or twisting injury.
Kay 2001 surgical treatment is recommended for open fractures, significantly displaced fractures, and displaced intraarticular fractures of the hallux. Article information, pdf download for nonsurgical management of isolated. Fractures of the base of the middle phalanx of the finger classification, management and longterm results noritaka seno, hiroyuki hashizume, hajime inoue, junya imatani, yoshiaki morito from okayama university medical school and okayama saiseikai general hospital, japan we classi. The first and fifth toes are most commonly involved as these are the border digits. If your pain is mild, you make take tylenol acetaminophen instead. Displaced spiral fractures generally display shortening or rotation, whereas displaced transverse fractures may display angulation. Fractures of the proximal phalanx hand and finger orthopedic. Even subtle injuries, such as a simple finger jam, can lead to decreased motion and a poor outcome if not diagnosed and treated promptly. The purpose of this study is to report the complications and outcomes of displaced proximal phalanx fractures after treatment with closed reduction and percutaneous pinning. Acumed hand fracture system the acumed hand fracture system is designed to provide both standard and fracturespecific fixation for metacarpal and phalangeal fractures, as well as fixation for fusions and osteotomies. Evidence based rehabilitation methods for best outcomes in phalanx fractures will be outlined includi recorded webinar. Diaphyseal fractures of the metacarpals and phalanges are common injuries that. The most common problem following phalanx fractures is stiffness, and the best means to prevent this is early protected motion. Athlete to wear splint that is least confining for protection per doctor and wrapped with approved.
Manual compression is applied across the fracture site during wire insertion. Fracture of the proximal phalanx in the right little finger. Although access to this page is not restricted, the information found here is intended for use by medical providers. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Fractures of the distal phalanx make up the majority of hand fractures involved in industrial accidents. Distal phalangeal fractures must be examined for the presence of a nail bed laceration. Seymour fractures, displaced juxtaepiphyseal fractures of the distal phalanx with associated nailbed injury, occur in children and have been reported to have relatively high complication rates. Pediatric phalanx fractures are one of the most common fractures in children. Fractures of the distal phalanx the distal phalanx is common fracture in the hand. These views are included in a full radiographic series of the third phalanx, usually when a fracture is suspected. Foot fractures phalanx pediatric orthopaedic society.
Phalangeal fractures are the most common fracture of the forefoot. Tarsal phalanges fractures orthopaedicsone articles. Middle phalanx undisplaced fractures impaction pdf most of the documents on the racgp website are in portable document format pdf. The purpose of this investigation was to assess the complications and outcomes of displaced proximal phalanx fractures in children treated with closed reduction and percutaneous pinning. The distal metaphysis, which anchors the complex nail matrix and nail plate, is. Most fractures involving the hand in children appear simple and they usually are able to be treated by simple means. Fractures of the base of the middle phalanx are usually intraarticular and often require surgical treatment.
The vast majority of pediatric foot fractures do well with nonoperative management. Bragdon, md department of orthopaedics division of upper extremity surgery december 3, 2010 metacarpal and phalangeal fractures 10% of all upper extremity fractures 70% occur between the ages of 1145 md ilihdimost are treate d nonoperatively with reduction, protective splinting, and early mobilization. Nonsurgical management of isolated proximal phalangeal fractures. To open a pdf file you will need compatible software such as adobe reader. Open fracture aka a compound fracture of the middle phalanx of the right middle finger.
Most extraarticular proximal phalanx fractures can be managed conservatively with acceptable results. Dip extension splint used for distal finger injuries for protection and support percutaneous pinning at distal finger dip hyperextension splint mallet fingers ulnarradial gutter splint used for fractures of the hand. Pdf most of the documents on the racgp website are in portable document format pdf. Despite the prevalence of proximal phalanx fractures in children, there is sparse literature on the outcomes of any treatment option. Pdf management of phalangeal fractures of hand researchgate. The mechanism of injury usually results from a direct blow to the tip of the finger that causes forced flexion of the dip joint. In two 9% cases the reduction was not accepted on follow up assessment and the fractures were managed surgically. May 01, 2000 fractures of the proximal phalanx hand and finger orthopedic dr. Fractures of the proximal phalanx hand and finger orthopedic dr. Crush injuries to the distal phalanx are also common and can result in nail trauma and open fractures. Take home points a swollen finger can mean a lot of things active rom of all joints should be present even if rom normal, serious injury can be present limited romstrength should not persist note the direction of displacement if possible when in doubt, get an x. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. A proximalthird fracture usually angulates with an apex dorsal deformity as the flexor digitorum superficialis flexes the distal fragment, and the central slip extends the proximal fragment. General treatment principles of phalangeal fractures.
Pt notes driving to the goal when his shot was blocked as the ball was leaving his hand. Little leaguers elbow physeal stress fractures avulsion fractures ocds of the capitellum. The goal of proximal phalangeal fracture management is to. Middle phalangeal fractures are less common than proximal and distal phalanx fractures. Each phalanx consists of a proximal base, body and distal head. Evaluation and management of toe fractures american family. Jan 10, 2017 keywords achilles tendon rupture ankle fracture calcaneus fracture jones fracture proximal 5th metatarsal lisfranc injury metatarsal fractures tarsal navicular fracture tibial plafond pilon fracture talar neck fractures lateral process of talus fracture phalanx fractures of the foot.
The middle phalanx is injured with an axial force, parallel to the shaft. A distalthird fracture tends to angulate with an apex volar deformity from the action of the flexor digitorum superficialis on the proximal fragment. Pdf avulsion fractures from the base of phalanges of the. Inthecase of a metacarpal neck or diaphysis fracture, reduction was achieved manually.