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Phalangeal Shaft Fracture

synonyms: phalanx fracture

Phalangeal Shaft Fracture ICD-9

  • Unspecified = 816.00 (closed), 816.10(open)
  • Proximal or middle phalanx = 816.01(closed), 816.11(open)
  • Distal phalanx = 816.02(closed), 816.12(open)
  • Multiple sites = 816.03(closed), 816.13(open)

Phalangeal Shaft Fracture Etiology / Epidemiology / Natural History

  • Common injury

Phalangeal Shaft Fracture Anatomy

  • DIP extension is provided by the the conjoined lateral bands which insert into the base of the distal phalanx
  • Conjoined lateral bands are made up of the lateral slips of the extrinsic extensor tendon and the lateral bands from the intrinsic interosseous and lumbrical muscles.
  • DIP flexion is provided by FDP insertion into the volar base. Injury to the FDP at this level results in a Jersey Finger.
  • See Hand Anatomy.

Phalangeal Shaft Fracture Clinical Evaluation

  • Evaluate finger cascade with flexion. Any overlaps of injured digits indicates need for reduction +/- fixation.

Phalangeal Shaft Fracture Xray

  • P/A, lateral abd oblique views of affected finger

Phalangeal Shaft Fracture Classification / Treatment

  • Undisplaced (>2mm translation, >20 degrees angulation, no clinical deformity): Treatment = static or dynamic splinting (buddy taping). Follow weekly initially to ensure reduction is maintained (Maitra A, J Hand Surg 1992;17Br:332).
  • Displaced transverse or short oblique: may be stable after reduction. If stable apply static splint in functional position for 4-6weeks. Unstable = CRPP vs ORIF. Consider transcutaneous mini-screws.
  • Displaced Long oblique = Almost always unstable = CRPP(CPT=26727). Consider transcutaneous mini-screws. ORIF if fails closed reduction.
  • Open fracture: consider mini-external fixation. (Freeeland AE, CORR, 1987;214:93)

Phalangeal Shaft Fracture Associated Injuries / Differential Diagnosis

Phalangeal Shaft Fracture Complications

  • Loss of reduction
  • Delayed union
  • Malunion
  • Nonunion
  • Tendon adhesion / stiffness
  • Nerve or vascular injury

Phalangeal Shaft Fracture Follow-up

  • Post-op /Initial: Place in alumifoam extension / clamshell. Elevation.
  • 7-10 Days: xray to ensure reduction is maintained. Continued splint, activity modifications. Immobilize as few joints as necessary.
  • 6 Weeks: Remove k-wire, wean from splint use as soon as callus is visible on xray. Continue activity modifications. Agressive DIP ROM.
  • 3 Months: Resume full activities. Assess ROM. May require flexor/extensor tendon tenolysis to regain motion.
  • 1Yr: assess outcomes / follow-up xrays.
Phalangeal Shaft Fracture Review References
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