The Knee: Reconstruction, Replacement  and Revision Tracking Pixel
Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Characteristics of Phalangeal and Metacarpal Fracture





- Phalangeal Injury
Location   Pattern     Skeleton     Deformity   Soft Tissue   Injury     Motion
Base       Transverse   Simple       Angulation     Closed     Skin       Stable
Shaft     Oblique     Impacted     Dorsal         Open       Tendon     Unstable
Neck       Spiral       Comminuted   Palmar                   Ligament
Condyle   Avulsion     Bone loss   Rotation                 Nerve
Epiphysis                         Shortening               Blood Vessel
- Acceptable Alignment: (phalangeal & metacarpal frx)
    - 10 deg angulation in both sagittal and coronal planes except in
          metaphysis, where 20 deg angulation in sagittal plane is accepted;
    - up to 45 deg angulation in sagittal plane in neck of 5th metacarpal;
    - 50% overlap at the fracture;
    - no rotation deformity;
    - frx that is markedly displaced before reduction did not necessarily
          require internal fixation after adequate reduction;
- Stable Frx:
    - include closed impacted shaft frx;
    - frx w/ little or no displacement;
    - most distal phalangeal frxs;
    - many isolated metacarpal shaft frxs;
- Unstable Fractures:
    - rotated Spiral Fractures
    - comminuted fractures
    - severely displaced fractures
    - some short Oblique Fractures
    - multiple fractures
    - subcondylar proximal phalanx fractures
    - palmar base middle phalanx fractures
    - fractures with associated extensive soft tissue injury
    - displaced articular fractures: Bennett's and reversed Bennett's



Original Text by Clifford R. Wheeless, III, MD.