Condylar Fracture

- Discussion:
    - this fracture most commonly splits off a single condyle, resulting in disruption of the joint and angular deformity of the finger;
    - common atheletic injury;
    - best diagnosed with an oblique x-ray;
    - can be mistreated as sprain which results in finger angulation and irregularity;

- Non Operative Treatment:
    - may be indicated if high quality radiographs (including oblique views) fail to show any displacement;
    - w/ non operative therapy, regular x-rays need to be taken to ensure that displacement does not occur;
    - generally need to immobilize for 3-4 weeks;

- Treatment:
    - ORIF is indicated w/ more than 2 mm displacement;
    - ORIF requires exact anatomic restoration of articular surface;
    - exposure:
         - Chamay approach:
                - indicated for fractures over the distal 1/3 of the proximal phalanx;
                - make a dorsal longitudinal skin incision over the phalanx;
                - make a distally based "V shaped" flap incision into the extensor mechanism;
                - this allows the central slip to be reflected distally and does not interfere with the lateral bands;
         - joint is entered either by splitting the extensor mechanism or by elevating lateral bands and entering the joint dorsolaterally;
         - minimize soft tissue stripping and attempt to leave the collateral ligament attached to the condyle;
    - stabilize with two K wires (0.28 or 0.35) or a small screw;
          - intraosseous wiring is another option;
    - bicondylar fractures are more difficult to reduce

Distal unicondylar fractures of the proximal phalanx.

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

Last updated by Data Trace Staff on Tuesday, May 22, 2012 1:06 pm