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Base of Proximal Phalanx

- See: Complex MP Joint Dislocations;

- Discussion:
    - marginal fractures of the base of the base of the proximal phalanx involving MP joint usually represent avulsion fractures of collateral 
    - often there is a significant sized palmar-ulnar or palmar radial fragment;

- Non Operative Treatment:
    - nondisplaced marginal fracture of the base of the proximal phalanx can be adequately managed by buddy taping;
    - larger fractures may require reduction and internal fixation;

- Operative Fixation:
    - consider dorsal approach;
    - small fragments can be held w/ K wire while larger fragments may be held with screws;
    - avulsion fractures:
          - in the report by KM Kuhn et al, 10 patients with 11 avulsion fractures at the base of the proximal phalanx associated with collateral 
                 ligament instability were treated with open reduction and internal fixation using a volar A1 pulley approach;
          - all fractures healed between 5 and 9 weeks (average, 6 weeks);
          - after an average 19.4-month follow-up period all patients had full ROM of the MP joint, collateral ligament stability, and grip strength 
                 of at least 90% of the uninjured hand

Volar A1 pulley approach for fixation of avulsion fractures of the base of the proximal phalanx