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SH Type III Phalangeal Frx



- Discussion: 
   - most often occur in adolescents and pre-adolescents; 
   - most often occurs in proximal phalanx due to anatomy of ligamentous insertions; 
   - in middle phalanx, SH III frx arise from tendinous avulsions at insertion of the central slip or the volar plate; 

- Treatment
- volar avulsion: 
   - immobilized in 30 deg of flexion;
- dorsal avulsion frx: 
   - w/ minimally displaced frx (less than 2mm displacement and less than 25% of joint surface), fracture can be immobilized in extension; 
   - w/ displaced frx, consider ORIF w/ K wires