- See:
- Characteristics of Phalangeal and Metacarpal Fracture:
- Injury to the Phalanges:
- Discussion:
- important deforming force is the insertion of central slip into the dorsum of the base of the middle phalanx & insertion of flexor digitorum
superficialis volarly;
- central slip has a well defined area of insertion, and its action is to extend the middle phalanx;
- although action of FDS is to flex middle phalanx, its insertion is rather complex & is not confined to short segment of phalanx;
- FDS has a prolonged insertion, extending from a point just distal to flare of the base to a point only a few mm proximal to the neck;
- ie. they form a broad expanse of tendon beneath the profundus;
- SH Type III Frx:
- Angulation:
- frx through neck of middle phalanx is likely to have volar angulation, as proximal fragment tends to be flexed by strong pull of superficialis;
- frx through base of middle phalanx is more likely to be dorsally angulated owing to extending force of central slip on proximal fragment &
flexing force on distal fragment by superficialis;
- frx through middle 2/3 of bone may be angulated in either direction or not at all; not always predicatable on basis of tendon insertion;
- typically proximal to the FDS insertion - angulate dorsally;
- typically distal to the FDS insertion - angulate volarly;
- Non Operative Treatment:
- Casting:
- w/ dorsal angulation at the frx site, consider holding injured digit in slight flexion;
- Buddy Taping:
- encourages pt to move fingers, while the fracture heals;
- certain undisplaced fractures and impacted fractures of the phalanges are ideally suited for buddy taping but only if frx is truly stable
(undisplaced with no angulation in any plane - esp volar angulation);
- Operative Treatment:
- condylar frx: 
- middle phalanx dorsal base avulsion fractures:
- orif if 2 mm displaced or extension lag (boutonniere) will occur;
- may be associated w/ PIP dislocation
- shaft frx:
Operative treatment of intra-articular fractures of the dorsal aspect of the distal phalanx of digits.
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.