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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.