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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.