Figure 1. Anteroposterior radiograph of left thumb.
Figure 2. Lateral view of the left thumb.
A 23-year-old man presents with left thumb pain after falling down a ladder 2 days earlier. The patient recounts that his thumb jammed on the side of the ladder and he had immediate pain and swelling at the interphalangeal joint of the left thumb. Radiographic images of the left thumb (Figures 1 and 2) show a displaced intra-articular fracture of the distal aspect of the proximal phalanx.
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Phalangeal fracture is one of the most common types of fractures seen in the upper extremity. The most common mechanisms of injury include a direct blow or accidental fall. Failure to recognize and appropriately treat proximal phalanx fractures can lead to significant hand disability. Displaced intra-articular fractures can lead to problems with flexion and extension, deformities, joint instability, joint stiffness, and eventual post-traumatic arthritis.1,2
Prolonged nonoperative treatment of the fracture with immobilization often leads to a stiff and painful finger, which often can be permanent. Surgical fixation of the injury is also challenging as the fracture fragments are often small making it difficult to achieve an anatomical reduction and fixation. The most common methods of surgical fixation include the use of K-wire or screw and plate fixation. Plate fixation is generally used for larger fracture patterns because adequate bone stock is required for stable fixation with a screw. The primary goal of fixing a displaced intra-articular fracture, therefore, is to restore a congruent joint space to mitigate post-traumatic arthritis. The joint must be immobilized for 4 weeks postoperatively after fracture fixation to allow for fracture healing.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
1. Boyer JS, London DA, Stepan JG, Goldfarb CA. Pediatric proximal phalanx fractures: outcomes and complications after the surgical treatment of displaced fractures. J Pediatr Orthop. 2015;35(3):219-223. doi:10.1097/BPO.0000000000000253
2. Hornbach EE, Cohen MS. Closed reduction and percutaneous pinning of fractures of the proximal phalanx. J Hand Surg Br. 2001;26:45-49. doi:10.1054/jhsb.2000.0524