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Phalangeal Fracture

Phalangeal Fractures
Distal

Phalanx:

Extra-articular fractures are common, associated


with significant soft tissue injury.
Crush injuries from a perpendicular force (injuries
from a car door or hammer)

Intra-articular fractures are associated with extensor


tendon avulsion (Mallets finger), FDP tendon
avulsion (Jersey finger).
Examination:
Inspection:.
Neurovascular status should be examined.
Palpation is done for tenderness.

Closed treatment is recommended with splinting


and if necessary closed reduction

Phalangeal Fractures
Middle

Phalanx:

Blunt or crush force perpendicular to the long axis of the


bone.
Angulation and rotation are two features of instability
that must be examined.
Rotational deformities are serious injuries and are
detected clinically.
Examination:
Inspection: for dislocations and sublaxations. Ask patient to fully
flex the phalanx to examine alignment of digits.
Palpation: swelling and tenderness

Treatment:
Nondisplaced without impaction: require only dynamic splinting
for 2-3 weeks.
Angulation and rotation require closed reduction and splinting to
restore finger alignment.

Phalangeal Fractures
Proximal

Phalanx:

More common than middle phalanx fractures.


May result in a great deal of disability.
Dorsal or palmar angulation may occur with these
fractures.
Examination:
Inspection:
Neurovascular status
Palpation is done for tenderness.

Treatment:
Nondisplaced fractures: usually stable and treated by
closed reduction and dynamic splinting.
Angulated or unstable fractures may require internal or
external fixation.
4

PHALANGEAL FRACTURES

FRACTURES OF DISTAL PHALANX


Classificatuion:1)tuft #
simple #
comminuted#
Shaft #---transversestable or unstable
----longitudinal
Articular#---volar, epiphyseal,dorsal

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TREATMENT OF DISTAL PHALANGEAL #

TUFT #-drain subungual hematoma


finger splint
Shaft #-- CRIFk-wire
Epiphyseal #--ORIF
Complications nonunion
-malunion

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FRACTURES OF MID & PROXIMAL PHALANX

ARTICULAR #(london)--1)condylar #
Type1-stable #without displacement
Type2-unicondyle,unstable
Type3-bicondyle,comminuted

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dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

UNICONDYLAR FRACTURES

Classification-Weiss &Hastings
Class1-oblique volar
Class2-longsaggital
Class3-dorsal coronal
Class4-volarcoronal
Treatment-CRIF OR ORIF with k-wire or screws
AT 5-7DAysarom, splint PIP in full extension
Remove k wires 3-4 weeks

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TREATMENT OF BYCONDYLAR FRACTURES

ORIF WITH PLATES & SCREWS


Dynamic splint
External fixation
Interfragmentary screws

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PSEUDOBOUTTONOUIRE DEFORMITY

IN FRACTURES OF HEAD OF PHALANX WHEN


THERE IS DISPLACED collateral ligamentous
injury & healing occurs ,when there is adhesions
between the adjacent lateral band,& oblique
retinacular ligament& volar plate

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Other fractures of head of phalanx

1)avulsion # of dorsal base of mid phalanx>detachment of central tendon insertions a


result of ant pip jt dislocation
Treatment- ORIF

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CONT.

#lateral base of proximal or mid phalanxit


represents collat ligament avulsion
Treatment-a) uncomplicatedsplint for 10-14
days
B) complicatedORIF with k-wire
# BASE OF PROXIMAL PHALANXTreatment-ORIF

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Cont

SHAFT # INVOLVING JOINTTreatment ORIF


Proximal traction phalanx splintnoninvasive, minimal stiffness, comminuted#

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NECK FRACTURES

Common in toddlers
Classification->type1-nondisplaced
type2-displaced with some bone contact
Type3-completely displaced
Treatment-ORIF with k-wire or

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SHAFT FRACTURES

They can be transverse, oblique, spiral,


comminuted
Treatment
1)nondisplaced & stable-cock-up position
2)displaced-stable after CR-cock-up position slab
Displaced unstable after reductionA) spiral &oblique-CR& IF with kwire

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CONT

Transverse#-ORIF with kwire& intra osseous wire


Displaced unstable & comminuted-external
fixation,miniplate & screws

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COMPLICATIONS OF PHALANGEAL FRACTURES

MALUNION-classified-a) malrotation,volar
angulation,lateral angulation,
It is usually seen after oblique or spiral #
Treatment-osteotomy with plate
fixation,lateralwedge osteotomy,corrective
osteotomy

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CONT

Intrarticular malunion
Nonunion
Loss of motion
Pip joint extensor lag
infection

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Fractures of the thumb bones


Fractures of phalanx-a) extra articular
B) Intra articular
EXTRA ARTICULAR-1)distalplongitudnal,transervse,tuft
Treatment-repair of dermal nail matrix, application
of splint,CRIF WITH k wire, ORIF with k wire

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sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


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FRACTURES OF PROXIMAL PHALANX

Head & neck#-CRIF WITH K WIRE


ORIF WITH K WIRE
Angulation of 20-30* is unacceptable

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dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

dr sumer yadav, mch plastic surgery.


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Intraarticular # & avulsion

1)dorsal base of distal phalanx-mallet thumb


Treatment-external splint
2)ulnar base of proximal phalanx-game keeper
thumb
Treatment-reinsertion of collateral ligament or
CRIF with k wire

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com

thank you

dr sumer yadav, mch plastic surgery.


sumeryadav2004@gmail.com