Phalangeal neck fractures of the proximal phalanx of the fingers in adults

Abstract

Introduction The outcome of adult phalangeal neck fractures of the proximal phalanx of the fingers has not been previously investigated. Purpose To report the outcome of adult phalangeal neck fractures of the proximal phalanx of the fingers following a specific management protocol. Methods A total of 10 phalangeal neck fractures of the proximal phalanx of the fingers in nine adult male patients are presented. Three patients presented with type I (undisplaced) fractures and these were treated with splinting for 3 weeks. There were a total of five type II (displaced but with bone-to-bone contact) fractures: two were stable after closed reduction and were treated with splinting alone and the other three were unstable requiring Kirschner (K)-wire fixation. The last patient had a type III (displaced with no bone-to-bone contact) fracture, which was treated with open reduction and K-wire fixation. We emphasised that K-wires should not immobilise any of the finger joints to allow immediate active motion after surgery. Results All fractures healed clinically and radiologically without complications. The outcome in our series, following our management protocol, was excellent in one patient and good in the remaining eight patients. Conclusion Phalangeal neck fractures of the proximal phalanx in adults are rare and there are not many available options for fixing unstable type II/III fractures. Our protocol of management and the technique of K-wire fixation (leaving both the proximal interphalangeal and metacarpophalangeal joints free) followed by early active mobilisation gives consistent satisfactory results.