An Evidence-Based Guide for Managing Phalangeal Fractures | Journal CME Article-Journal CME Article: An Evidence-Based Guide for Managing Phalangeal Fractures Article

Journal CME Article: An Evidence-Based Guide for Managing Phalangeal Fractures Article

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Phalangeal fractures constitute a significant portion of upper extremity injuries, ranking second in prevalence after distal radius and ulna fractures. These fractures are most commonly seen in children aged 5 to 14 years, with the highest occurrence in males. Pediatric phalangeal fractures often result from sports-related crush injuries, while in adults, work-related injuries are most frequent. The distal phalanx is the most commonly fractured phalanx.<br /><br />Phalangeal fractures are categorized based on anatomical location (proximal, middle, or distal), fracture pattern (transverse, oblique, spiral, comminuted, or impacted), degree of displacement, and articular involvement. Radiographic evaluation through three-view hand radiographs is crucial, with additional imaging like MRI or CT used for suspect soft tissue or occult injuries.<br /><br />Treatment approaches for these fractures depend on their stability and involvement of articular surfaces. Nonoperative treatments include splinting or buddy taping, sometimes accompanied by closed reduction. Operative interventions involve various methods, such as percutaneous pinning or open internal fixation, especially in unstable fractures or those affecting joint alignment.<br /><br />Within the context of distal phalanx injuries, tuft fractures often arise from crush incidents, frequently involving nail bed damage. Treatment focuses on decompression and stabilization with nonoperative means in uncomplicated cases, and surgical intervention in more severe injuries. Seymour fractures, open fractures with nail-bed involvement, particularly in children, must be correctly identified to avoid complications like growth deformities.<br /><br />For middle and proximal phalangeal fractures, whether intra-articular or extra-articular, stabilization via Kirschner wires or plates is considered based on complexity and stability. Rehabilitation strategies post-stabilization play a vital role in maintaining range of motion and preventing stiffness.<br /><br />Overall, phalangeal fracture management emphasizes accurate assessment and tailored treatment plans to optimize healing, function, and minimizing potential long-term deficits. Advances and innovations in surgical techniques, such as wide-awake hand surgery, continue to enhance treatment outcomes.

Keywords

phalangeal fractures

upper extremity injuries

pediatric fractures

sports-related injuries

work-related injuries

fracture treatment

radiographic evaluation

distal phalanx

Seymour fractures

wide-awake hand surgery