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Fig. 1

(A) The rotational deformity of the 4th finger nail plate was noted. (B) The deformity was aggravated with finger flexion.

Fig. 2

(A) We cannot see the specific fracture line on plain X-ray postero-anterior view. (B) The hamated fracture line was observed on a computed tomography imaging (arrow).

Fig. 3

(A) Damaged skin and soft tissue of the left hand was observed. (B) The reversed flow radial forearm flap was harvested. (C) Five months after flap surgery.

Fig. 4

Various treatments for distal phalangeal fractures. (A-C) Distal phalangeal fracture with nail bed injury. After closed reduction and K-wire fixation, the nail bed was repaired. Finally, the nail was reinserted and tied. (D, E) The avulsed fragment of the distal phalanx base dorsal aspect was noted. Extension block K-wiring was used. (F, G) Flexor digitorum profundus avulsion fracture at the distal phalanx was observed. Open reduction and hook plate fixation was performed.

Fig. 5

Various situations and treatment of middle, proximal phalangeal fracture. (A) Due to interaction of flexor digitorum superficialis (FDS) and extensor tendon central slip, dorsal angulation deformity was made at the middle phalangeal base fracture. (B) Because of traction of FDS, volar angulation was made at the middle phalangeal neck fracture. (C, D) Angulated and comminuted fracture of the proximal phalanx. Complete union was achieved with open reduction and plate fixation. (E-H) Crush injury at the middle phalanx. An open comminuted fracture and a severely damaged, dirty wound was observed. After dirty and devitalized tissue was debrided, temporary K-wire fixation was performed. At 2nd stage operation, auto iliac bone block graft and plate fixation was performed. A flap was required for skin coverage.

Fig. 6

Example of metacarpal fracture treatments. (A, B) A proximal phalanx collateral ligament avulsion fracture was observed. Closed reduction and K-wire fixation was performed. (C, D) A displaced, comminuted 2nd metacarpal head fracture. One headless screw and 1 miniscrew were used for fixation. (E, F) Multiple metacarpal neck fractures. Intramedullary nailing was performed at the 2, 3, and 5th metacarpal neck fracture. (G, H) Angulated and comminuted 5th metacarpal neck fracture. Intramedullary nailing with bouquet technique was performed. (I, J) Angulated and comminuted 5th metacarpal neck fracture. Transverse K-wire fixation was performed to the adjacent intact 4th metacarpal bone shaft. (K, L) Multiple metacarpal shaft fractures were noted. Plate fixation for the 2nd metacarpal bone, 3 lag screws for the 3rd metacarpal bone, and intramedullary nailing for the 4th metacarpal bone were used for each fracture. (M, N) Multiple comminuted metacarpal fractures. Complete union was achieved by locking plate.

Fig. 7

Various treatments of 1st metacarpal fractures. (A, B) A comminuted fracture of the 1st metacarpal shaft. Bony union was observed with plate fixation. (C, D) A 1st metacarpal base intraarticular fracture (Bennett fracture) was observed on a computed tomography image. After achieving satisfactory reduction with closed method, K-wire fixation was performed. (E, F) A 1st metacarpal base intraarticular comminuted fracture. Closed reduction was attempted, but failed. Therefore, open reduction and 2 screws fixation were performed. (G, H) A 1st metacarpal base intraarticular comminuted fracture. Comminution is very severe. We tried with limited minimal open reduction to achieve joint congruency and additional K-wire fixation and external fixation was applied.

Fig. 8

(A) Proximal interphalangeal joint flexion, distal interphalangeal joint joint hyperextension deformity (buttonhole deformity). (B) Severe valgus instability was checked on physical examination, which indicates a complete radial collateral ligament tear. (C-E) Second metacarpophalangeal joint dorsal dislocation was observed on imaging study. In the operating room, metacarpal head buttonholes into the palm (Kaplan deformity) was observed. The volar plate is interposed between the base of the proximal phalanx and metacarpal head. Lumbricalis is on the radial side, flexor tendon is on the ulnar side of the protruded metacarpal head. (F) Interposition of the adductor aponeurosis between the distal site of attachment of the ruptured ligament and the detached ligament, thus preventing ligamentous healing and restoration of joint stability. In this situation, only operative intervention will allow apposition and healing of the ligament in an anatomic position (arrow).

Table 1

Examination and Management of Finger Dislocations and Fractures

Diagnosis	Examination and initial treatment	Management	Recommendations for operation
PIP dislocation	Identify direction (dorsal, volar, lateral)	Dorsal: Splint and early range of motion	Fractures involving greater than 30%-40% of the intra-articular surface, reduction is difficult or unsuccessful, the patient is unable to obtain full extension following reduction
	Attempt reduction	Volar: Splint in extension if there is an associated central slip
	Check for neurovascular status and soft tissue injuries (volar plate in dorsal dislocation, central slip in volar dislocation)
	Obtain postreduction radiographs
MCP dislocation (especially in the thumb)	Attempt reduction	Splint and early range of motion for simple dislocations	Reductions requiring anesthesia, open reductions
	Check for neurovascular status and soft tissue injuries
	Obtain postreduction radiographs (soft tissue injuries often impede reduction)
DIP dislocation	Attempt reduction	Splint and early range of motion	Complicated injuries
	Check for neurovascular status and soft tissue injuries
	Obtain postreduction radiographs
Distal phalanx fracture (tuft fracture)	Common in crush injuries	Splint for two to four weeks followed by range of motion; hyperesthesia, pain, and numbness common for up to six months following injury	Rarely needed
	Assess for tenderness at distal phalanx
	Obtain radiographs
Mallet fracture	Assess for inability to extend at DIP joint	Splint DIP joint in extension for eight weeks	Conservative treatment is ineffective; large displaced bony fragment or significant volar subluxation
	Radiographs show a bony fragment at dorsal surface of the proximal distal phalanx
Flexor digitorum profundus avulsion fracture	Assess for inability to flex at the DIP joint	Referral recommended (possible flexor digitorum profundus retraction)	All injuries
	Radiographs show a bony fragment at volar surface of the proximal distal phalanx
Middle or proximal phalanx fracture	Assess for tenderness over phalanx	Buddy taping and early range of motion	Displaced, oblique, or spiral fractures
	Radiographs confirm diagnosis

PIP: Proximal interphalangeal, MCP: Metacarpophalangeal, DIP: Distal interphalangeal.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by  

• Current Concepts in Management of Phalangeal Fractures
  Yohan Lee, Sunghun Park, Jun-Ku Lee
  Journal of the Korean Fracture Society.2022; 35(4): 169.     CrossRef