Proximal/Middle Phalanx

Question 1

Pathophys & Clin Features

Answer 1

• typically have volar angulation
• proximal phalanx has No tendinous attachments
• middle phalanx: tendon of FDS divides & inserts along nearly the entire volar surface of the phalanx & extensor tendon inserts on the proximal dorsal base
• result: #s at base of mid phalanx usually result in dorsal angulation Vs #s at neck of mid phalanx resulting in volar angulation
• radiograph hints: condylar #s req oblique views Or rotational deformities on lateral views as discrepancies in diameter
• rotationally alignment must be assessed clinically: alignment of fingers moving into fist shape

Question 2

Management

Answer 2

• anatomic alignment important: tansverse # stable, oblique # NOT
• non-displaced #s: buddy taping/dynamic splinting
• displaced/unstable: wrist & fingers to be splinted; circular cast/outrigger/gutter/anterior/posterior splints
• immobilisation should not exceed 3 wks
• RICE principles
• unstable/intra-articular/spiral/oblique/midshaft transverse: inherently unstable & req surg fixation

Question 3

Complications

Answer 3

• malunion: most common; malrotation/shortening/volar or lateral angulation
• volar angulation of proximal phalangeal # >25-30 degrees results in pseudoclawing
• diminished motion: tendon adhesions & stiffness in the PIP after intra-articular #s w incongruity