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Phalangeal Neck Fracture

synonyms:

Phalangeal Neck 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 Neck Fracture Etiology / Epidemiolgy / Natural History

Phalangeal Neck Fracture Anatomy

  • usually distal fragment displaces into extension.  Proximal metaphyseal fragment occludes the volar subchondral fossa and blocks IP flexion.
  • Collateral ligaments preserve blood supply to distal fragment.  If open reduction is needed, ensure collateral ligaments are preserved.  (Yousif NJ, J Hand Surg Am 1985;10:852-861)

Phalangeal Neck Fracture Clinical Evaluation

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

Phalangeal Neck Fracture Xray

  • P/A and lateral views of affected finger
  • 30-45 degree suppinated or pronated views

Phalangeal Neck Fracture Classification / Treatment

Phalangeal Neck Fracture CRPP Technique

  • Belsky MR, J Hand Surg 1984;9Am:725
  • 0.045 (1.1mm) K-wires generally used. Consider 0.062in(1.6mm) for larger bones(metacarpal); 0.035in(0.9mm) for smaller bones (pediatric fx).
  • Closed reduction under c-arm guidance.
  • one or more intramedullary or two crossed K-wires.
  • K-wires must not cross at the fracture site.
  • K-wires are left in until fracture callus in visible on xray. Usually 3-4 weeks

Phalangeal Neck Fracture Associated Injuries / Differential Diagnosis

Phalangeal Neck Fracture Complications

  • Flexion Contracture: see Hogan CJ, JAAOS 2006;14:524.
  • loss of reduction
  • delayed union
  • malunion: if radiolucency is still evident, attempt percutaneous pin osteoclasis with CRPP.  Avoid central extensor mechanism. Pin may be used to lever fx volarly to restore subchondral fossa.  (Bernstein SM, J Pediatr Orthop 1993:13;85-88)   If fully healed consider osteotomy (Simmons BP, J Hand Surg Am 1987;12:1079-1082) or remodeling in pediatric pts (Hennirkus WL, JBJS Br 2003;85:273-274)
  • tendon adhesion / stiffness
  • nerve or vascular injury

Phalangeal Neck Fracture Follow-up

Phalangeal Neck Fracture Review References

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