proximal phalanx fracture foot orthobullets proximal phalanx fracture foot orthobullets

Patients typically present with pain, swelling, ecchymosis, and difficulty with ambulation. Am Fam Physician, 2003. In some cases, a Jones fracture may not heal at all, a condition called nonunion. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Based on the radiographs shown in Figure A, what is the most appropriate next step in treatment? Lesser toe fractures can be treated with buddy taping and a rigid-sole shoe for four to six weeks. Referral is indicated if buddy taping cannot maintain adequate reduction. Thank you. Nondisplaced or minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts with less than 10 of angulation can be treated conservatively with a short leg walking boot, cast shoe, or elastic bandage, with progressive weight bearing as tolerated. ClinPediatr (Phila), 2011. Your doctor will then examine your foot and may compare it to the foot on the opposite side. A combination of anteroposterior and lateral views may be best to rule out displacement. Started in 1995, this collection now contains 6407 interlinked topic pages divided into a tree of 31 specialty books and 722 chapters. Unless it is fairly subtle, rotational deformity should be corrected by further manipulation. If your doctor suspects a stress fracture but cannot see it on an X-ray, they may recommend an MRI scan. Examination reveals a well-aligned foot with ecchymosis and swelling on the plantar aspect of the 1st MTP joint. Hyperflexion or hyperextension injuries most commonly lead to spiral or avulsion fractures. (Right) Several weeks later, there is callus formation at the site and the fracture can be seen more clearly. (Left) In this X-ray, a recent stress fracture in the third metatarsal is barely visible (arrow). Sesamoid bones generally are present within flexor tendons in the first toe (Figure 1, top) and are found less commonly in the flexor tendons of other toes. Copyright 2023 American Academy of Family Physicians. While you are waiting to see your doctor, you should do the following: When you see your doctor, they will take a history to find out how your foot was injured and ask about your symptoms. Which of the following acute fracture patterns would best be treated with open reduction and internal fixation? A fracture may also result if you accidentally hit the side of your foot on a piece of furniture on the ground and your toes are twisted or pulled sideways or in an awkward direction. If there is a break in the skin near the fracture site, the wound should be examined carefully. For acute metatarsal shaft fractures, indications for surgical referral include open fractures, fracture-dislocations, multiple metatarsal fractures, intra-articular fractures, and fractures of the second to fifth metatarsal shaft with at least 3 mm displacement or more than 10 angulation in the dorsoplantar plane. Referral is recommended for children with fractures involving the physis, except nondisplaced Salter-Harris type I and type II fractures (Figure 6).4. The use of musculoskeletal ultrasonography may be considered to diagnose subtle metatarsal fractures. An avulsion fracture is also sometimes called a "ballerina fracture" or "dancer's fracture" because of the pointe position that ballet dancers assume when they are up on their toes. Hallux fractures. In P_STAR, 2 distraction pins are placed 1.5 cm proximal and distal to the fracture site in clearance of the distal radial physis. Proper . These include metatarsal fractures, which account for 35% of foot fractures.2,3 About 80% of metatarsal fractures are nondisplaced or minimally displaced, which often makes conservative management appropriate.4 In adults and children older than five years, fractures of the fifth metatarsal are most common, followed by fractures of the third metatarsal.5 Toe fractures, the most common of all foot fractures, will also be discussed. 21(1): p. 31-4. In one rural family practice,1 toe fractures comprised 8 percent of 295 fractures diagnosed; in an Air Force family practice residency program,2 they made up 9 percent of 624 fractures treated. The Ottawa Ankle and Foot Rules should be used to help determine whether radiography is needed when evaluating patients with suspected fractures of the proximal fifth metatarsal. The most common symptoms of a fracture are pain and swelling. Phalangeal fractures are very common, representing approximately 10% of all fractures that present to the emergency room. Physical examination should include assessment of capillary refill; delayed capillary refill may indicate circulatory compromise. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which makes fractures about the physis likely. Metatarsal shaft fractures near the head or base of the first to fourth metatarsal with any degree of displacement or angulation are often associated with concomitant injuries and generally take longer to heal. Narcotic analgesics may be necessary in patients with first-toe fractures, multiple fractures, or fractures requiring reduction. Patients typically present with varying signs and symptoms, the most common being pain and trouble with ambulation. Three muscles, viz. abductor, interosseous and adductor linked with proximal phalanx may aggravate fracture of the toe bones if these muscles get sudden pull. Maffulli, N., Epiphyseal injuries of the proximal phalanx of the hallux. If more than 25% of the joint surface is involved or if the displacement is more than 2 to 3 mm, closed or open reduction is indicated. What is the optimal treatment for the proximal phalanx fracture shown in Figure A? These tendons may avulse small fragments of bone from the phalanges; they also can be injured when a toe is fractured. This information is provided as an educational service and is not intended to serve as medical advice. After that, nonsurgical treatment options include six to eight weeks of short leg nonweight-bearing cast with radiographic follow-up to document healing at six to eight weeks.2,6,20 If evidence of healing is present (callus formation and lack of point tenderness) at that time, weight-bearing activity can progress gradually, along with physical therapy and rehabilitation. Some metatarsal fractures are stress fractures. Indications. Minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts (Figure 2) and fractures with less than 10 of dorsoplantar angulation in the absence of other injuries can generally be managed in the same manner as nondisplaced fractures.24,6 Initial management includes immobilization in a posterior splint (Figure 311 ), use of crutches, and avoidance of weight-bearing activities. During the exam, the doctor will look for: Your doctor will also order imaging studies to help diagnose the fracture. X-rays. Initial management of a Jones fracture includes a posterior splint and avoidance of weight-bearing activity, with follow-up in three to five days. 68(12): p. 2413-8. Most fractures can be seen on a routine X-ray. Follow-up should occur within three to five days to allow for reduction of soft tissue swelling. This is followed by gradual weight bearing, as tolerated, in a cast or walking boot. J AmAcad Orthop Surg, 2001. To unlock fragments, it may be necessary to exaggerate the deformity slightly as traction is applied or to manipulate the fragments with one hand while the other maintains traction. ROBERT L. HATCH, M.D., M.P.H., AND SCOTT HACKING, M.D. Approximately 10% of all fractures occur in the 26 bones of the foot. Therefore, phalanges and digits adjacent to the fracture must be examined carefully; joint surfaces also must be examined for intra-articular fractures (Figure 3). Treatment Most broken toes can be treated without surgery. Primary care physicians are often the first clinicians patients see for foot injuries, and fractures are among the most common foot injuries they evaluate.1 This article will highlight some common foot fractures that can be managed by primary care physicians. Copyright 2016 by the American Academy of Family Physicians. The choice of immobilization device depends on the patient's ability to ambulate with the device with minimal to no pain. Dislocation refers to displacement in which the two articular surfaces are no longer in contact, in contrast to subluxation, in which there is some contact (may be referred to as complete versus simple dislocation in some texts). Because of the first toe's role in weight bearing, balance, and pedal motion, fractures of this toe require referral much more often than other toe fractures. A Jones fracture has a higher risk of nonunion and requires at least six to eight weeks in a short leg nonweight-bearing cast; healing time can be as long as 10 to 12 weeks. Copyright 2003 by the American Academy of Family Physicians. A, Dorsal PIPJ fracture-dislocation. A positive metatarsal loading test, which involves manual axial loading of the metatarsal, may exacerbate the pain and help differentiate a fracture from a soft tissue injury.3. Because it is the longest of the toe bones, it is the most likely to fracture. A Jones fracture is a horizontal or transverse fracture at the base of the fifth metatarsal. If the wound communicates with the fracture site, the patient should be referred. Reduction of fractures in children can usually be accomplished by simple traction and manipulation; open reduction is indicated if a satisfactory alignment is not obtained. Hand (N Y). Healing rates also vary considerably depending on the age of the patient and comorbidities. We help you diagnose your Toe fractures case and provide detailed descriptions of how to manage this and hundreds of other pathologies . Ulnar gutter splint/cast. The thumb connects to the hand through the next joint, known as the metacarpophalangeal (MCP) joint. Proximal phalanx fractures occur in an apex volar angulation (dorsal angulation). Shaft. Clin OrthopRelat Res, 2005(432): p. 107-15. A fractured toe may become swollen, tender, and discolored. This procedure is most often done in the doctor's office. Follow-up/referral. Lgters TT, If no healing has occurred at six to eight weeks, avoidance of weight-bearing activity should continue for another four weeks.2,6,20 Typical length of immobilization is six to 10 weeks, and healing time is typically up to 12 weeks. Most displaced fractures of the lesser toes can be managed by family physicians if there are no indications for referral. CrossRef Google Scholar PubMed 7 DeVries, JG, Taefi, E, Bussewitz, BW, Hyer, CF, Lee, TH. While celebrating the historic victory, he noticed his finger was deformed and painful. Proximal phalanx fractures are often angulated at the time of presentation (independent of mechanism) as muscle forces deform the unstable shaft. Although adverse outcomes can occur with toe fractures,3 disability from displaced phalanx fractures is rare.5. 118(2): p. e273-8. The reduced fracture is splinted with buddy taping. Toe fractures of this type are rare unless there is an open injury or a high-force crushing or shearing injury. High-impact activities like running can lead to stress fractures in the metatarsals. The proximal fragment flexes due to interossei, and the distal phalanx extends due to the central slip. All Rights Reserved. Your video is converting and might take a while Feel free to come back later to check on it. If you need surgery it is best that this be performed within 2 weeks of your fracture. Referral is indicated in patients with circulatory compromise, open fractures, significant soft tissue injury, fracture-dislocations, displaced intra-articular fractures, or fractures of the first toe that are unstable or involve more than 25 percent of the joint surface. Healing of a broken toe may take 6 to 8 weeks. The distal phalanx and proximal phalanx connect via the interphalangeal (IP) joint, which allows you to bend the tip of your thumb. A fracture, or break, in any of these bones can be painful and impact how your foot functions. Type in at least one full word to see suggestions list, 2022 California Orthopaedic Association Annual Meeting, COA Foot and Ankle End - Glenn Pfeffer, MD, Comminuted Fifth Metatarsal Fracture in 28M. Fracture position ideally will be maintained when traction is released, but in some cases the reduction can be held only with buddy taping. 11(2): p. 121-3. most common injuries to the skeletal system, distal phalanx > middle phalanx > proximal phalanx, 40-69 years old - machinery is most common, assess for numbness indicating digital nerve injury, assess for digital artery injury via doppler, proximal fragment pulled into flexion by interossei, distal fragment pulled into extension by central slip, apex volar angulation if distal to FDS insertion, apex dorsal angulation if proximal to FDS insertion, diagnosis confirmed by history, physical exam, and radiographs, type III - unstable bicondylar or comminuted, proximal fragment in flexion (due to interossei), distal fragment in extension (due to central slip), extraarticular fractures with < 10 angulation or < 2mm shortening and no rotational deformity, 3 weeks of immobilization followed by aggressive motion, extraarticular fractures with > 10 angulation or > 2mm shortening or rotational deformity, Unstable patterns include spiral, oblique, fracture with severe comminution, Eaton-Belsky pinning through metacarpal head, minifragment fixation with plate and/or lag screws, lag screws alone indicated in presence of long oblique fracture, proximal fragment in flexion (due to FDS), distal fragment in extension (due to terminal tendon), due to inherent stability provided by an intact and prolonged FDS insertion, proximal fragment in extension (due to central slip), results from hyperextension injury or axial loading, unstable if > 40% articular surface involved, represents avulsion of collateral ligaments, usually stable due to nail plate dorsally and pulp volarly, often associated with laceration of nail matrix or pulp, shearing due to axial load, leading to fracture involving > 20% of articular surface, avulsion due tensile force of terminal tendon or FDP, leading to small avulsion fracture, terminal tendon attaches to proximal epiphyseal fragment, nail matrix may be incarcerated in fracture and block reduction, distal phalanx fractures with nailbed injury, dorsal base fractures with > 25% articular involvement, displaced volar base fractures with large fragment and involvement of FDP, predisposing factors include prolonged immobilization, associated joint injury, and extensive surgical dissection, treat with rehab and surgical release as a last resort, Apex volar angulation effectively shortens extensor tendon and limits extension of PIPJ, surgery indicated when associated with functional impairment, corrective osteotomy at malunion site (preferred), metacarpal osteotomy (limited degree of correction), most are atrophic and associated with bone loss or neurovascular compromise, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). Copyright 2023 Lineage Medical, Inc. All rights reserved. Nail bed injury and neurovascular status should also be assessed. toe phalanx fracture orthobulletsdaniel casey ellie casey. Great toe fractures are treated with a short leg walking boot or cast with toe plate for two to three weeks, then a rigid-sole shoe for an additional three to four weeks. Fourth and fifth proximal/middle phalangeal shaft fractures and select metacarpal fractures. rest, NSAIDs, taping, stiff-sole shoe, or walking boot in the majority of cases. Open fractures, Infection, Compartment syndrome 3; References, Classification, Courses 3; Distal articular. Spiral fractures often lead to rotation or shortening, and transverse fractures lead to angulation.6. protected weightbearing with crutches, with slow return to running. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Joint hyperextension, a less common mechanism, may cause spiral or avulsion fractures. The video will appear on the video dashboard once complete. This content is owned by the AAFP. We help you diagnose your Hand Proximal phalanx case and provide detailed descriptions of how to manage this and hundreds of other pathologies. As your pain subsides, however, you can begin to bear weight as you are comfortable. Patients with a proximal fifth metatarsal fracture often present after an acute inversion of the foot or ankle. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. The distal phalanx is the most common location for a non-physeal injury which typically involves a crushing mechanism, and the most common location for physeal injury is the proximal phalanx. Fractures can affect: Causes of lesser toe (phalangeal) fractures Trauma (generally something heavy landing on the toe or kicking an immovable object) Treatment of lesser toe (phalangeal) fractures Non-displaced fractures Transverse and short oblique proximal phalanx fractures generally are treated with Kirschner wires, although a stable short oblique transverse shaft fracture can be managed with an intrinsic plus splint. When this happens, surgery is often required. The skin should be inspected for open fracture and if . Taping your broken toe to an adjacent toe can also sometimes help relieve pain. Most metatarsal fractures can be treated with an initial period of elevation and limited weight bearing. Patients should limit icing to 20 minutes per hour so that soft tissues will not be injured. Metatarsal shaft fractures are initially treated with a posterior splint and avoidance of weight-bearing activities; subsequent treatment consists of a short leg walking cast or boot for four to six weeks. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Although tendon injuries may accompany a toe fracture, they are uncommon. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. And finally, the webinar will cover fixation techniques, including various instrumentation options.Moderator:Jeffrey Lawton, MDChief, Hand and Upper ExtremityProfessor, Orthopaedic SurgeryAssociate Chair for Quality and Safety, Orthopaedic SurgeryProfessor, Plastic SurgeryUniversity of MichiganAnn Arbor, MichiganFaculty: Charles Cassidy, MDHenry H. Banks Professor and ChairmanDepartment of OrthopaedicsTufts Medical CenterBoston, MassachusettsChaitanya Mudgal, MD, MS (Ortho), MChHand Surgery ServiceDepartment of OrthopedicsMassachusetts General HospitalChairman, AO NA Hand Education CommitteeAssociate Professor, Orthopedic Surgery, Harvard Medical SchoolBoston, MassachusettsAmit Gupta, MD, FRCSProfessorDepartment of Orthopaedic SurgeryUniversity of LouisvilleLouisville, KentuckyRebecca Neiduski, PhD, OTR/L, CHTDean of the School of Health SciencesProfessor of Health SciencesElon UniversityElon, North Carolina, Ring Finger Proximal Phalanx Fracture in 16M. Even if the fragments remain nondisplaced, significant degenerative joint disease may develop.4. 2017 Oct 01;:1558944717735947. Application of a gentle axial loading force distal to the injury (i.e., compressing the distal phalanx toward the foot) may distinguish contusions from fractures. Minimally displaced (less than 3 mm) avulsion fractures typically require immobilization and support with a short leg walking boot. The next bone is called the proximal phalanx. Stress fractures are small cracks in the surface of the bone that may extend and become larger over time. Because it is the longest of the toe bones, it is the most likely to fracture. Patients with unstable fractures and nondisplaced, intra-articular fractures of the lesser toes that involve more than 25 percent of the joint surface (Figure 3) usually do not require referral and can be managed using the methods described in this article. Search dates: February and June 2015. The "V" sign (arrow) indicates dorsal instability. In most cases, this is done by simply adjusting the direction of traction to correct any shortening, rotation, or malalignment. Avertical Lachman test will show greater laxity compared to the contralateral side. A stress fracture can also come from a sudden increase in physical activity or a change in your exercise routine. Recent studies have demonstrated that musculoskeletal ultrasonography and traditional radiography have comparable accuracy, sensitivity, and specificity in the diagnosis of foot and ankle fractures9,10 (Figure 1). In children, toe fractures may involve the physis (Figure 2). Open reduction and placement of two 0.045-inch K-wires placed longitudinally through the metacarpal head, Application of a 1.5-mm straight plate applied dorsally through and extensor tendon splitting approach, Open reduction and lag screw fixation with 1.3mm screws through a radial approach, Placement of a 1.5-mm condylar blade plate through a radial approach, Open reduction and retrograde passage of two 0.045-inch K-wires retrograde trough the PIP joint. Patients usually cannot bear full weight and sometimes will ambulate only on the medial aspect of the foot. Methods: We reviewed the most current literature on various treatment methods of proximal phalanx fractures, focusing on the indications and outcomes of nonoperative as well as operative interventions. An AP radiograph is shown in FIgure A. Metatarsal fractures are among the most common injuries of the foot that may occur due to trauma or repetitive microstress. Phalangeal fractures are the most common foot fracture in children. RESULTS: Stable fractures can be successfully treated nonoperatively, whereas unstable injuries benefit from surgery. If the reduction is unstable (i.e., the position is not maintained after traction is released), splinting should not be used to hold the reduction, and referral is indicated. Injuries to this bone may act differently than fractures of the other four metatarsals. In most cases, a fracture will heal with rest and a change in activities. Interosseus muscles and lumbricals insert onto the base of the proximal phalanx and flex the proximal fragment. Displaced fractures of the lesser toes should be treated with reduction and buddy taping. stress fracture of the proximal phalanx MRI indications positive bone scan hyperdorsiflexion injury with exam findings consistent with a plantar plate rupture abnormal radiographs persistent pain, swelling, weak toe push-off not recommended routinely findings will show disruption of volar plate Proximal phalanx (finger) fracture Contents 1 Background The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity [1] Extensor tendons and interosseous muscles commonly causes volar angulation [1] Clinical Features Finger pain Differential Diagnosis Hand and Finger Fractures (Right) The bones in the angled toe have been manipulated (reduced) back into place. They are common in runners and athletes who participate in high-impact sports such as soccer, football, and basketball. If it does not, rotational deformity should be suspected. Metacarpal Fractures Hand Orthobullets Fractures Of The Proximal Fifth Metatarsal Radiopaedia Fifth Metacarpal Fractures Statpearls Ncbi Bookshelf In many cases, a stress fracture cannot be seen until several weeks later when it has actually started to heal, and a type of healing bone called callus appears around the fracture site. The forefoot has 5 metatarsal bones and 14 phalanges (toe bones). A radiograph taken at the time of injury is shown in Figure A, and a current radiograph is shown in Figure B. There is typically swelling, ecchymosis, and point tenderness to palpation at the fracture site. To check proper alignment, radiographs should be taken immediately after reduction and again seven to 10 days after the injury (three to five days in children).4 In patients with potentially unstable or intra-articular fractures of the first toe, follow-up radiographs should be taken weekly for two or three weeks to monitor fracture position. Surgery is required in the case of an open fracture, when there is significant displacement, or instability after reduction. The proximal phalanx is the toe bone that is closest to the metatarsals. Author disclosure: No relevant financial affiliations. Evidence has shown that, depending on symptoms, short leg walking boots are superior to short leg walking casts.18,19 Immobilization in a cast or boot is typically only needed for two weeks, with progressive ambulation and range of motion thereafter as tolerated. MB BULLETS Step 1 For 1st and 2nd Year Med Students. More sensitive than an X-ray, an MRI can detect changes in the bone that may indicate a fracture. toe phalanx fracture orthobullets An MRI is performed and selected cuts are shown in Figures B and C. What is this patients diagnosis? The same mechanisms that produce toe fractures may cause a ligament sprain, contusion, dislocation, tendon injury, or other soft tissue injury. Which of the following is responsible for the apex palmar fracture deformity noted on the preoperative radiographs? Diagnosis can be made clinically and are confirmed with orthogonal radiographs. Referral is indicated for patients with first metatarsal fractures with any displacement or angulation. Epub 2012 Mar 30. Abductor, interosseus, and adductor muscles insert at the proximal aspects of each proximal phalanx. This content is owned by the AAFP. During this time, it may be helpful to wear a wider than normal shoe. While on call at the local rural community hospital, you're called by an emergency medicine colleague. Referral also should be considered for patients with other displaced first-toe fractures, unless the physician is comfortable with their management. Fractures in this area can occur anytime there is a break in the compact bone matrix that makes up the proximal phalanx. DAVID BICA, DO, RYAN A. SPROUSE, MD, AND JOSEPH ARMEN, DO. The proximal phalanx is the toe bone that is closest to the metatarsals. If this maneuver produces sharp pain in a more proximal phalanx, it suggests a fracture in that phalanx. In some practice sites, family physicians manage open toe fractures; a discussion about the management of this type of injury can be found elsewhere.3,4 Patients also may require referral because of delayed complications such as osteomyelitis from open fractures, persistent pain after healing, and malunion. She has no history of ankle or foot trauma, and medical history is significant only for delayed menarche. (OBQ18.111) The image shows a diagram of where these bones lie in the footthe midpoint of the proximal phalanges being where to the toes branch off from the main body of the foot. Foot fractures are among the most common foot injuries evaluated by primary care physicians. After anesthetizing the toe with ice or a digital block, the physician holds the tip of the toe, applies longitudinal traction, and manipulates the bone fragments into proper position. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. All material on this website is protected by copyright. Patients usually present with a painful, swollen, ecchymotic toe with variable deformity and gait disturbance. 2017, Management of Proximal Phalanx Fractures & Their Complications, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, PIP Fracture & Dislocation: Case of the Week - Shaan Patel, MD, Proximal Phalanx Fracture: Case of the Week - Michael Firtha, DO, Proximal Phalanx Fracture Surgery by Dr. Thomas Trumble, Ring Finger Proximal Phalanx Fracture in 16M, Fracture of the base of proximal phalanx of 5th finger. The pull of these muscles occasionally exacerbates fracture displacement. Lightly wrap your foot in a soft compressive dressing. (Left) X-ray shows a Jones fracture at the base of the fifth metatarsal (arrow). Physical examination findings typically include tenderness to palpation, swelling, ecchymosis, and sometimes crepitation at the fracture site. METHODS: We reviewed the most current literature on various treatment methods of proximal phalanx fractures, focusing on the indications and outcomes of nonoperative as well as operative interventions. Although often dismissed as inconsequential, toe fractures that are improperly managed can lead to significant pain and disability. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. What is the most likely diagnosis? Your foot may become swollen and discolored after a fracture. and C.W. Patients with a proximal fifth metatarsal fracture often present after an acute inversion of the foot or ankle. Unlike an X-ray, there is no radiation with an MRI. Acute fractures to the proximal fifth metatarsal bone: Development of classification and treatment recommendations based on the current evidence. Adjuvant imaging techniques to analyze fracture geometry and plan implant placement, will be discussed in detail. - See: Phalangeal Injury Menu: - Discussion: - fractures of the proximal phalanx are potentially the most disabling fractures in the hand; - direct blows tend to cause transverse or comminuted frx, where as twisting injury may cause oblique or spiral fracture; - proximal fragments are usually flexed by intrinsics while distal fragments are extended due to extrinsic compressive forces; Plate fixation . Fracture Fixation, Internal Bone Plates Fracture Fixation Bone Nails Fracture Fixation, Intramedullary Bone Screws Bone Wires Range of Motion, Articular Hemiarthroplasty Arthroplasty Casts, Surgical Treatment Outcome Arthroplasty, Replacement Internal Fixators Retrospective Studies Bone Transplantation Reoperation Injury .