What is included in the treatment of proximal phalanx during the maintenance phase?

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

For displaced fractures, splinting is used after reduction, with the wrist in slight extension and the metacarpophalangeal joint flexed to 70°. Free motion is allowed at the PIP and DIP joints for early tendon motion. Oblique and spiral fractures are usually unstable after reduction and require splinting with either ulnar or radial gutter splints that extend to the distal phalanx. In the proximal phalanx, the surrounding tendons lie in close proximity to the periosteum, and there is a susceptibility to adhesions and stiffness during the healing process. Therefore, appropriate fracture alignment, stability, and early motion are very important. [8] One study in patients with extra-articular fractures of the proximal phalanges examined the use of a cast that allowed unrestricted motion of the wrist, and that fixed the MCP joints in 70 to 90 degrees of flexion with buddy taping of the fingers. [9] This cast allowed quicker return of wrist motion and showed similar healing of fractures compared toastatic forearm-fingercastinan intrinsic-plus position. [9]

Fok et al report on 10-year results managing proximal phalangeal fractures with dynamic treatment. [10] A dynamic splint that kept the metacarpophalangeal joint maximally flexed while allowing free movement of the proximal and distal interphalangeal joints of the injured finger was applied for at least 4 weeks. Results were evaluated using the Belsky classification and grip strength assessment. The results of 97 patients (103 fractures) were analyzed. At a minimum 1-year follow-up, 75% of patients attained excellent or good results. Neither nonunion nor delayed fracture union was noted. The 25% of patients who attained poor results were older than those who attained excellent or good results (average age, 53.1 vs 35.1 years, respectively) and tended to comply poorly with the rehabilitation program. Using the stabilizing effect of the zancolli complex-metacarpophalangeal retention apparatus and a metacarpophalangeal block splint, bone healing and movement recovery can be achieved simultaneously. [10]


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