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Non Operative Treatment of Stable Proximal Phalanx Frx


- See: Phalangeal Injury Menu:

- 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

Treatment principles for proximal and middle phalangeal fractures.

Articular fractures of the digits: a prospective study.

A prospective study of 245 open digital fractures of the hand.

Role of antibiotics in open fractures of the finger.

Distal unicondylar fractures of the proximal phalanx.

An analysis of proximal phalangeal fractures.

A comparative mechanical analysis of plate fixation in a proximal phalangeal fracture model.

Complications in phalangeal and metacarpal fracture management. Results of tenolysis.   

Tenolysis and capsulectomy after hand fractures.