Middle Phalanx Frx   

- See:
      - Characteristics of Phalangeal and Metacarpal Fracture:
      - Injury to the Phalanges:

- Discussion:
    - important deforming force is the insertion of central slip into the dorsum of the base of the middle phalanx & insertion of flexor digitorum 
         superficialis volarly;
    - central slip has a well defined area of insertion, and its action is to extend the middle phalanx;
    - although action of FDS is to flex middle phalanx, its insertion is rather complex & is not confined to short segment of phalanx;
    - FDS has a prolonged insertion, extending from a point just distal to flare of the base to a point only a few mm proximal to the neck;
         - ie. they form a broad expanse of tendon beneath the profundus;
    - SH Type III Frx:

- Angulation:
    - frx through neck of middle phalanx is likely to have volar angulation, as proximal fragment tends to be flexed by strong pull of superficialis;
    - frx through base of middle phalanx is more likely to be dorsally angulated owing to extending force of central slip on proximal fragment &
          flexing force on distal fragment by superficialis;
    - frx through middle 2/3 of bone may be angulated in either direction or not at all; not always predicatable on basis of tendon insertion;
         - typically proximal to the FDS insertion - angulate dorsally;
         - typically distal to the FDS insertion - angulate volarly;

- Non Operative Treatment:
    - Casting:
         - w/ dorsal angulation at the frx site, consider holding injured digit in slight flexion;
    - Buddy Taping:
         - encourages pt to move fingers, while the fracture heals;
         - certain undisplaced fractures and impacted fractures of the phalanges are ideally suited for buddy taping but only if frx is truly stable 
              (undisplaced with no angulation in any plane - esp volar angulation);

- Operative Treatment:
    - condylar frx:
    - middle phalanx dorsal base avulsion fractures:
         - orif if 2 mm displaced or extension lag (boutonniere) will occur;
         - may be associated w/ PIP dislocation

    - shaft frx:


Operative treatment of intra-articular fractures of the dorsal aspect of the distal phalanx of digits.

Treatment principles for proximal and middle phalangeal fractures.

Articular fractures of the digits: a prospective study.

A prospective study of 245 open digital fractures of the hand.

Role of antibiotics in open fractures of the finger.

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

Last updated by Data Trace Staff on Tuesday, May 22, 2012 2:11 pm