Apic G, Mentzel M, Röhm A, Schöll H, Gülke J
Zentrum für Chirurgie, Klinik für Unfallchirurgie, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland,
Unfallchirurg. 2014 Jun;117(6):533-8. doi: 10.1007/s00113-013-2380-7.
In this study 56 dorsal phalangeal fractures of the distal segment were classified regarding morphological criteria.
Clinical and radiological results after 4 months were analyzed. Fractures including subluxation of the distal interphalangeal joint occurred rarely (n=3) and were treated by surgery. Fractures without subluxation had either a triangle-shaped fragment (n=40) or a fragment similar to a hunter's hat (n=9). Furthermore, there were two fractures with a tiny bony avulsion and two fractures with more radial or ulnar-oriented fragments. The triangle and hunter's hat type fractures were treated either by splinting (n=20) or by open reduction and stabilization with screws and wires (n=29).
Clinical outcome was similar in both groups. In 12 out of the 20 fractures treated by splinting a stepping of the joint surface had to be tolerated. Initially only 8 out of 20 fractures showed a stepping of the joint surface. The fractures treated by surgery showed a better radiological outcome.
Initially 27 fractures showed a stepping in the joint line but after surgical treatment only 9 fractures still presented a stepping. The remaining four fractures were successfully treated by splinting.
