Types and Treatment of Phalangeal Fractures

Phalangeal fracture is a type of fracture with a high incidence rate. It is usually caused by direct external force. The phenomenon of displacement after phalangeal fracture is very obvious. How should phalangeal fracture be treated?

1. Types of phalangeal fractures

(I) Proximal phalanx fracture

It is mostly caused by indirect violence, with diaphyseal fractures being the most common. The distal end of the fracture is pulled by the extensor tendon, often causing angular deformity toward the palm side.

(ii) Middle phalanx fracture

Direct force on the middle phalanx can cause transverse fractures, while indirect force can cause oblique or spiral fractures. Different deformities may occur due to different fracture sites.

(III) Distal phalanx fracture

The fracture of the tuberosity and phalanx is usually caused by direct violence, such as being hit by a heavy object, or being squeezed. In mild cases, there is only a bone crack, while in severe cases, the bone may be broken into pieces, often with soft tissue lacerations. Because there is no local tendon traction, the fracture generally has no obvious displacement or deformity.

2. Treatment Methods

Fractures must be correctly reduced and aligned, and anatomical reduction must be achieved as much as possible. There must be no angulation, rotation, overlapping, displacement, or deformity, so as not to hinder the normal sliding of the tendons and cause varying degrees of functional impairment of the fingers. Closed fractures can be reduced manually and fixed with a splint. Open fractures of the phalanges should be thoroughly cleaned to achieve primary healing of the wound. If there is skin damage, the damage must be repaired by various methods to avoid exposing bones and tendons, and to prevent tendon necrosis, scar contraction, and bone infection.

In case of open comminuted fracture of phalanges, the larger bone fragments cannot be removed casually to avoid bone loss and nonunion. After debridement of open fracture, manual reduction and splint fixation can also be performed. When reducing, the distal end of the fracture should be aligned with the proximal end of the fracture. The finger should be fixed in the functional position as much as possible, which requires both adequate fixation and appropriate movement.