What is the role of surgery in the treatment of middle phalanx fractures?

Updated: Jan 18, 2018
  • Author: Jay E Bowen, DO; Chief Editor: Craig C Young, MD  more...
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For fractures of the middle phalanx, if conservative treatment is not sufficient, then percutaneous pinning or open reduction using K-wires is used. [11] Plates or screws are not regularly used at the phalangeal level because there is too much soft-tissue damage in the process (although Giesen et al reported successful treatment of proximal and middle phalangeal fractures in 26 patients with intramedullary headless compression screws [12] ). Displacement of the bone around the center of the longitudinal axis is rotational.

A retrospective review study by Ridley et al that included 695 patients who underwent fixation of phalangeal, metacarpal, or distal radius fractures with K-wires reported that pin-site infections were more likely in exposed K-wire cases than in buried K-wire cases. [13]

Malrotation is detected clinically, not radiographically. Patients should be asked to fully flex the phalanges; the long axis of the fingers should point to the scaphoid tubercle or the distal radius with the fingers parallel to each other. If suspected, a rotational deformity warrants surgical referral. A rotational deformity is often associated with spiral, oblique, or comminuted fractures.

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