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RACS ASC 2024

Proximal Phalanx fractures: Conservative management with Mobilisation Splinting

Verbal Presentation

Verbal Presentation

2:54 pm

08 May 2024

Bealey 3

RESEARCH PAPERS

Disciplines

Hand Surgery

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Presentation Description

Institution: Northern Hospital - VIC, Australia

Proximal phalangeal fractures are tricky to treat because of high ratio of bone to tendon contact, which can increase adhesions. Adhesions formed between the extensor mechanism and the fracture may result in loss of extensor glide and resultant extensor lag at the proximal interphalangeal joint (PIPJ). Tethering of flexor digitorum profundus (FDP) can also result in decreased distal interphalangeal joint (DIPJ) flexion. These fractures ‘typically’ exhibit a distal end dorsal angulation with volar apex. Intrinsic muscles flex the proximal fragment, the distal fragment is extended by the attachment of the central slip to the dorsal lip of the middle phalanx. Volar apex and dorsal angulation of more than 15 degrees results in decreased efficiency of the extensor mechanism. Sagittal bands tighten causing progressive extensor lag, which is accentuated by phalangeal shortening. This subsequently leads to a fixed joint contracture. Burkhalter & Reyes (1984) proposed that unstable proximal phalanx fractures can be stabilised by exploiting the extensor apparatus. When metacarpophalangeal joint (MCPJ) flexes the extensor mechanism shifts distally two-thirds, embracing and directing compressive forces to the volar cortex increasing fracture stability. Our protocol includes closed extra-articular base or shaft fractures, initially unstable but correctable, similar with rotation correctable through closed reduction or positioning in clinic. All our patient had excellent results, without any rotation, malunion, non-union and achieving full grip before 12 weeks.

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Authors

Authors

Dr Tetyana Kelly - , Dr Nigel Mann - , Fiona Moate -