Phalangeal Neck Fracture 816.00

 

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 Base Fracture
  • Phalangeal Neck Fracture
  • Distal Phalanx Fracture

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

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer.