Impacted Fractures in the Proximal Portion of the Proximal Phalanx of the Finger

¹ From the Department of Orthopaedic Surgery, Duke University Medical Center and Watts Hospital, Durham

1. A ten-year-follow-up of sixty-eight patients with impacted fractures in the proximal third of the proximal phalanx in the hand (forty-one in children, twenty-seven in adults) revealed that two of six children over age ten had malunion with loss of significant flexion and extension of the proximal interphalangeal joint; of seventeen adults, nine had malunion and seven, first seen more than five weeks after injury, had angulation of 25 to 70 degrees with significant loss of both flexion and extension at the proximal interphalangeal joint.

2. The commonest causes of malunion were immobilization of the digit in insufficient flexion at the metacarpophalangeal and proximal interphalangeal joints, permitting loss of reduction and acceptance of oblique rather than true lateral roentgenograms for evaluation of angulation in fractures of the proximal phalanx, both before and after reduction.

3. Impacted fractures of the proximal portion of the proximal phalanx in the hand are more common in children than in adults. In younger children, residual angulation of 30 degrees or less should remodel without significant disability.

4. Uncorrected angulation of 25 degrees or more in the adult or older child usually results in loss of both flexion and extension of the proximal interphalangeal joint, aside from any adherence of tendon apparatus adjacent to the fracture site.

5. Fractures of the proximal phalanx in the hand should be immobilized with the wrist in functional extension, the metacarpophalangeal and proximal inter phalangeal joints flexed to a functional position and with the finger tip positioned three to four centimeters from the palm.

7. An open-wedge osteotomy with bone graft from the distal end of the radius or of the ulna is described for early malunion; and, transverse osteotomy with internal fixation may be necessary for older deformities and when osseous shortening is indicated.

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