What are the types of phalangeal fractures?

Updated: Jan 18, 2018
  • Author: Jay E Bowen, DO; Chief Editor: Craig C Young, MD  more...
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Answer

Fractures of the proximal phalanx are more common than fractures of the middle phalanges. Dorsal or palmar angulation may occur with these fractures, depending on their location. Nondisplaced fractures are usually stable and are treated with closed reduction and fixation. [2, 6] If significant comminution or segmental bone loss is present, these unstable fractures may require either internal or external fixation.

The proximal interphalangeal (PIP) joint is particularly vulnerable to injury as either an ligamentous or intra-articular fracture, with or without subluxation or dislocation. Middle phalangeal articular fractures at the PIP joint include dorsal lip fractures, palmar lip fractures, and central articular disruptions or pilon fractures. Avulsion and impaction sheer are 2 fracture mechanisms.

Middle phalanx palmar lip fractures are the most common form of osseous injury associated with PIP joint fracture-dislocations. Dorsal fracture-dislocation of the PIP joint is reported to occur in 9 of every 100,000 people each year. Many of these injuries are frequently ignored or treated inappropriately. As a result, there can be permanent swelling, pain, and variable degrees of stiffness, angulation, and degenerative changes.


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