Phalangeal Fractures

Fractures of the diaphysis of the middle and proximal phalanges are less common than those around the joints. Fracture types are transverse, oblique or spiral (Fig. 19.11). Dorsal tilting of the distal fragment is seen in angulated or displaced fractures (Fig. 19.12). It is essential to identify and correct any rotational deformity of phalangeal fractures, as it does not have the same remodelling potential as planar angulation. 

Fig. 19.16. Campbell s straight line method indicates a severely displaced phalangeal fracture...

Fig. 7.1. a Pseudofractures of the epiphyseal ossification centres (arrows). The curved epiphyseal plates of the middle phalanges are superimposed on the secondary ossification centres at their bases producing an effect simulating fractures at the lateral margins, b Overlapping soft tissues of the fingers simulate oblique fractures in a child... 

Accessory ossification centres may occur in the epiphyses of the metatarsals and phalanges of the toes. They are particularly common in the great toes (Fig. 7.50). Incompletely fused metatarsal pseudoepiphyses can be mistaken for fractures. These occur distally in the first metatarsal and proximally in the... 

With knowledge of common accidental fractures, the finding of a fracture at an unusual site will suggest an unusual mechanism of injury. In the absence of a history of an unusual mechanism, abuse should be considered. Unusual sites of fractures in infants and toddlers include phalanges (Fig. 11.9), meta-carpals, metatarsals, pelvis and scapula (Fig. 11.10). Pelvic fractures have been described in association with sexual abuse (Johnson et al. 2004). 

Fig. 11.9. Phalangeal and metatarsal fractures. The bases of the 3" and 4 metatarsals show increased density because of internal callus formation...

Middle and Proximal Phalanges 285 Condyle Fractures (Intra-articular) 285 Phalangeal Neck Fractures 286 Phalangeal Shaft 286 Proximal Phalanx 286 Volar Plate and... 

Fig. 19.10. Phalangeal neck fracture, lateral view. A bony spur projects into the subcondylar fossa (arrow)...

Fractures of phalangeal neck and shaft with typical dorsal angulation... 

Relative to the phalanges the metacarpals are reasonably protected, although several series of hand fractures found the fifth metacarpal to be the most frequently injured bone (Rajesh et al. 2001 Vadivelu et al. 2006). Incidence peaks in older schoolchildren, when the mechanism of injury is usually punching, or involvement in contact sports. 

Most metacarpal shaft fractures are spiral, indicating a torsional injury (Rajesh et al. 2001). As in the phalanges, careful assessment is required of rotational deformity, although this is probably more easily performed clinically than radiologically. Treatment is similar to phalangeal injuries. If stabilisation of the metacarpal is required to maintain reduction, K-wires which pass from the fractured metacarpal across to the adjacent, intact metacarpal can be inserted. 

A1 Qattan MM (2001) Phalangeal neck fractures in children classification and outcome in 66 cases. J Hand Surg [Br] 26 112-121... 

A1 Qattan MM (2002) Juxta-epiphyseal fractures of the base of the proximal phalanx of the fingers in children and adolescents. J Hand Surg [Br] 27 24-30 Anderson WJ (1987) Simultaneous fracture of the scaphoid and capitate in a child. J Hand Surg [Am] 12 271-273 Barton NJ (1979) Fractures of the phalanges of the hand in children. Hand 11 134-143... 

In Occupational medicine. State of the Art Reviews 1 285-300 Joung RS, Bry K, Ratner H (1977) Selective phalangeal tuft fractures in a guitar player. Br J Radiol 50 147-148 Kanerva L (1990) Physical causes of occupational skin disease. Mechanical trauma. In Adams, RM (ed) Occupational skin disease, 2nd edn. Saunders, Philadelphia, pp 41-65 Kanerva L (1996) Mechanical causes of occupational skin disease. In van der Valk P, Maibach HI (eds) The irritant contact dermatitis syndrome. CRC Press, Boca Raton, pp 195-204 Kanerva L (1999) Physical causes of occupational skin disease. In Adams RM (ed) Occupational skin disease, 3rd edn. Saunders, Philadelphia, 35-68... 

---