Proximal phalanx fracture
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Proximal phalanx fractures can be epiphyseal or shaft fractures and can be intra-articular or extra-articular. They are most often the result of forced rotation, hyperextension or direct trauma 2.
Proximal phalanx fractures are the most common pediatric hand fracture 1.
The fracture is generally well seen on plain radiographs, angulation of these fractures is best seen on the lateral projection 2. Ultrasonography can be used for fractures that are difficult to see or when there are doubts.
Treatment and prognosis
The clinical consolidation is in 4 or 6 weeks; radiological consolidation takes longer. However, it should be noted that the fingers don't tolerate immobilization very well so it should not exceed 3 weeks.
Treatment can be conservative in the case of a non-displaced fracture, but the method of immobilization may vary between orthopedic surgeons. Some use a splint in a palmar or dorsal position, fixating the wrist, MCP joint, and the entire finger, also immobilizing the adjacent finger. Others use a cast that fixates the wrist, metacarpophalangeal joint and proximal phalanx but allows movement of the interphalangeal joints.
Surgery is required in the case of an open fracture, when there is significant displacement, or instability after reduction. Surgical fixation involves Kirschner wires or very small screws.
- 1. Boyer JS, London DA, Stepan JG, Goldfarb CA. Pediatric proximal phalanx fractures: outcomes and complications after the surgical treatment of displaced fractures. (2015) Journal of pediatric orthopedics. 35 (3): 219-23. doi:10.1097/BPO.0000000000000253 - Pubmed
- 2. Ged G. Wieschhoff, Scott E. Sheehan, Jeremy R. Wortman, George S. M. Dyer, Aaron D. Sodickson, Ketan I. Patel, Bharti Khurana. Traumatic Finger Injuries: What the Orthopedic Surgeon Wants to Know. (2016) RadioGraphics. 36 (4): 1106-28. doi:10.1148/rg.2016150216 - Pubmed