![]() ![]() Early intervention with physical therapy, whether formal or informally, will prevent stiffness and secondary complications of phalanx fractures. Orthopedic specialty nursing can also assist with patient and family education, as well as monitoring progress and coordinate rehab, reporting status changes to the managing clinician. Nursing can follow up and assess the progress of treatment and subsequent therapy reporting concerns to the clinical team. All patients with phalanx fractures need to be followed to ensure that healing is occurring improper healing can affect function and quality of life. Regardless of the procedure, the patient has a period of immobilization, followed by an early range of motion. Since the majority of phalanx fractures initially present in the emergency department, the ED physician should be aware of the management and when to seek a consult from the orthopedic surgeon.Ĭare is taken to diagnose phalanx fractures correctly with physical exam and radiography, allowing guiding treatment to operative versus non-operative management. Managing phalanx fractures requires an interprofessional team of healthcare professionals that include nurses, occupational therapy, physical therapy, radiology, orthopedic surgery, and primary care physicians. Also, the accessory ligament and volar plate insertions, which make the fracture unstable. Dorsal proximal base fractures may be considered central slip avulsions. Proximal intra-articular fractures may be comminuted with axial load and considered “pilon” fractures. If the volar portion of the proximal base fracture constitutes approximately 40% of the articular surface, then it carries the majority of the proper collateral ligament insertion. Other ORIF options would be mini fragment plates and screws. Interfragmentary lag screw fixation would be indicated in long oblique fractures. The wires for either of these options are run in a parallel fashion, cross, or run transversely into the phalanx. ![]() The proximal fragment flexes due to interossei, and the distal phalanx extends due to the central slip.Ĭlosed reduction and internal fixation of proximal phalanx shaft fractures can be accomplished longitudinally through the metacarpal phalangeal joint but not the metacarpal head, or just through the metacarpal head known as Eaton-Belsky Pinning. Proximal phalanx fractures occur in an apex volar angulation (dorsal angulation). A fracture through the middle third may angulate in either direction or not at all as a result of the inherent stability provided by an intact and prolonged flexor digitorum superficialis insertion. Apex volar angulation occurs if the fracture is distal to the flexor digitorum superficialis insertion. Middle phalanx fractures occur in an apex dorsal or volar angulation depending on location. Apex dorsal angulation results from the fracture occurring proximal to the flexor digitorum superficialis (FDS) insertion so that the fragment becomes displaced by the pull of the central slip. Hyperflexion is usually the mechanism of injury and it presents as a mallet deformity with apex dorsal. ![]() Seymour fractures: this is a displaced epiphyseal injury of the distal phalanx associated with nail bed injury. This important anatomic relationship can lead to a swan neck deformity (a hyperextended PIPJ and flexed DIPJ). As the tendons transverse the PIPJ the flexor digitorum superficialis bifurcates into two slips that form the Camper's chiasm which inserts on the volar aspect of the middle phalanx. The flexor digitorum superficialis is volar, and the flexor digitorum profundus is dorsal. At the proximal interphalangeal joint (PIPJ), the flexor digitorum profundus and the flexor digitorum superficialis are within one sheath. The flexor digitorum profundus (FDP) inserts at the volar metaphysis of the distal phalanx. The distal phalanx anatomy includes the distal interphalangeal joint (DIPJ), which is enveloped by the extensor and flexor tendons along with the volar plate and collateral ligaments. The middle phalanx has two main insertions: the central slip (extensor mechanism) and the flexor digitorum superficialis (FDS). The proximal phalanx receives stabilization from the surrounding anatomy, including proper and accessory collateral ligaments, volar plate, and extensor/flexor tendons. The distal phalanx divides into the tuft, shaft, and base. The proximal and middle phalanges of the hand all possess a head, neck, shaft, and base. Early intervention is vital to allow healing and return of function. For the vast majority of phalanx fractures, an acceptable reduction is manageable with non-operative treatment. Injuries can occur at the proximal, middle, or distal phalanx. Phalangeal fractures of the hand are a common injury that presents to the emergency department and clinic. ![]()
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