Non Operative Treatment of Stable Proximal Phalanx Frx : Wheeless' Textbook of Orthopaedics

- Discussion:
- undisplaced frxs and impacted transverse frx of phalanges are treated w/ buddy taping assumming that:
- frx is stable (impacted and undisplaced);
- no angulation in any plane: (ie, there is no volar angulation);
- if the digit is immobilized for an extended periord of time, the flexor tendons can become adherent to the fracture site;
- it is therefore preferable to maintain tendon gliding while the fracture site heals;
    - over proximal phalanx, common extensor tendon particularly prone to adherence following fracture and/or laceration;
    - Lucerne cast
          - Extra-Articular Fractures of the Proximal Phalanges of the Fingers: A Comparison of 2 Methods of Functional, Conservative Treatment
    - buddy taping:
- encourages pt to move fingers, while the fracture heals;
- undisplaced frx & impacted frx of phalanges are suited for buddy taping but only if frx is truly stable (undisplaced w/ no angulation in
                any plane - esp volar angulation);
- casting w/ finger straight:
- may be indicated for a stable frx which requires a reduction;
- when casting these fractures, ensure that there is an adequate amount of MP joint flexion ie. > 60 deg of flexion;
- casting w/ finger flexed:
- unstable transverse fractures should be immobilized in flexion and are not amenable to buddy taping technique;
- spiral, oblique, transverse fractures are usually unstable;
- James Position:
- wrist 30 deg extension
- MP 70 deg flexion - here the collateral lig. are stretched to max and therefore do not become stiff;
- PIP < 20 deg flexion - these will become stiff in flexion, however, it is imperative that PIP joints be immobilized in sufficient flexion to correct this volar angulation;
- DIP 10 deg flexion