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Phalangeal Shaft Fracture S62.509A S62.609A 816.00

Thumb proximal phalanx fracture xray

Phalanx fracture xray

Finger extensor mechanism image

Thumb proximal phalanx ORIF xray

Proximal phalanx ORIF xray

Phalangeal base fracture xray

Phalangeal base fracture closed reduction

synonyms: phalanx fracture

Phalangeal Shaft Fracture ICD-10

Distal Phalanx Fracture - Right ICD-10
Middle Phalanx Fracture - Right ICD-10 
Proximal Phalanx Fracture - Right ICD-10

Distal Phalanx Fracture - Left ICD-10
Middle Phalanx Fracture - Left ICD-10 
Proximal Phalanx Fracture - Left ICD-10 

A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

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 Base Fracture
  • Phalangeal Neck Fracture
  • Distal Phalanx Fracture
  • Mallet finger

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

  • 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
  • Rockwood and Greens
  • Greens Hand Surgery