Abstract
The phalangeal fractures are common hand injuries. The unicondylar fractures of proximal phalanx are unique. They need prompt and accurate treatment to have a good functional outcome. We present a technique for managing a volar displaced (type 4) unicondylar fracture of the proximal phalanx. This provides accurate reduction and stabilization until fracture union, with minimal soft tissue tethering to allow early movement. A 26-years-old male sustained an injury to the right index finger while playing cricket. He attended fracture clinic complaining of pain and difficulty in moving the proximal interphalangeal (PIP) joint of the index finger. The X-ray showed a unicondylar fracture of the proximal phalanx in the coronal plane, with a displaced volar fragment. The patient was treated with open reduction and internal fixation with a single Kirschner wire (K-wire) passed from volar to dorsal aspect through the fragment. The patient commenced hand physiotherapy straight away and regained full range of movements. We report the technique of fixing the displaced unicondylar fractures of the proximal phalanx using single K-wire passed from the volar to dorsal aspect after open reduction of the fragment through a volar approach. This technique will allow early mobilization with very minimal soft tissue dissection thus preventing stiffness.
Highlights
The phalangeal fractures are common hand injuries
Coronal plane fractures may require open reduction and any metalwork must not be left in the joint [3]
The Xray showed a unicondylar fracture of the proximal phalanx in the coronal plane (Figure 1), with a displaced volar fragment
Summary
Unicondylar fractures of the phalangeal head are relatively common injuries. They are more common in young, active patients and define a specific fracture pattern [1]. A 26yearsold male with right dominant hand was seen in the fracture clinic following an injury to his right index finger. He worked as a computer sales representative. He sustained a hyperextension injury to his finger while playing cricket when the cricket ball hit his index finger tip He complained about pain and difficulty in moving the proximal interphalangeal (PIP) joint. The Xray showed a unicondylar fracture of the proximal phalanx in the coronal plane (Figure 1), with a displaced volar fragment. The Kwire was removed four weeks after surgery and the patient was referred for futher intensive physiotherapy He regained full range of movements of the PIP joint after eight weeks.
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