Phalangeal Base Fracture 816.00

synonyms:

Phalangeal Base 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 Base Fracture Etiology / Epidemiology / Natural History

Phalangeal Base Fracture Anatomy

Phalangeal Base Fracture Clinical Evaluation

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

Phalangeal Base Fracture Xray

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

Phalangeal Base Fracture Classification / Treatment

• Undisplaced, displaced unicondylar fx involving <25% of articular surface without joint subluxation/deformity: buddy taping
• Displaced unicondylar: Closed reduction under c-arm guidance, generally requires pointed reduction forceps. Cannulated reduction forceps facilitates K-wire placement. ORIF if closed reduction fails (Tan V, JOT 2005;19:518)
• Displaced Bicondylar: almost always unstable. CRPP. Generally joint is reduced and rixed with transverse k-wires placed parallel to joint surface. Metaphysis is then reduced and secured to the diaphysis with two K-wires inserted from the tip of each condyle proximally into the medullary canal distally. Also consider ORIF if closed recuction fails (Tan V, JOT 2005;19:518)
• Open fracture: consider mini-external fixation. (Freeland AE, CORR, 1987;214:93)

Phalangeal Base 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 Base Fracture ORIF Technique

• Mid-axial incision centered over fx

Phalangeal Base Fracture Associated Injuries

• Adjacent phalanx or metacarpal fractures
• Carpal fractures
• fight bite (high risk of injection)
• Phalangeal Shaft Fracture
• Phalangeal Neck Fracture
• Distal Phalanx Fracture

Phalangeal Base Fracture Complications

• Flexion Contracture: see Hogan CJ, JAAOS 2006;14:524.
• Loss of reduction
• Delayed union
• Malunion
• Tendon adhesion / stiffness
• Cold intolerance
• Numbness
• Abnormal nail growth
• Nerve or vascular injury

Phalangeal Base Fracture Follow-up

• Weekly follow-up until fracture callus is seen on xrays is indicated to ensure reduction is maintained
• Advance to passive ROM / Buddy taping as soon as fracture allows.

Phalangeal Base Fracture Review References

• Freeland AE, Geissler WB, Weiss AP, Operative Treatment of Common Displaced and Unstable Fractures of the Hand, JBJS 2001;83A:928-945
• Freeland AE, Orbay JL. ORIF of the Tubular Bones of the Hand In: Stickland JW, Grahma TJ, editor. Hand 2nd ed. Master Techniques in orthopedic surgery. Philadeplhia: Lippincott-Raven; 2004. p 3