A person is thumb-wrestling and suffers an unfortunate consequence. After the match, their ring finger is mostly tender and swollen around the MCP joint and stuck in a slightly flexed position. Here is the x-ray:
Diagnosis: comminuted proximal phalanx fracture
It doesn’t take much to figure that part out. The patient asks, “Will I need surgery?”
Wheeless Orthopedics:
“Fractures of the proximal phalanx are potentially the most disabling fractures in the hand”
Non-displaced fractures are usually stable and are treated with closed reduction/immobilization. In the presence of significant comminution or shortening, such unstable fractures may require either internal or external fixation.
Indications for operative repair of a phalanx fracture:
- Open fracture
- Displaced intra-articular fracture
- Fractures with severe soft-tissue loss
- Failure to achieve or maintain acceptable reduction using closed techniques
It’s difficult to tell from the one view that’s given here, but there is intra-articular involvement distally at the interphalangeal joint.
In any suspected hand fracture, consider checking for malrotation. This can be assessed by having the patient loosely make a fist: all fingers should point towards the proximal portion of the scaphoid.
No amount of rotational deformity is acceptable. Failing to correct this problem can lead to permanent deformity and loss of function.
