Phalangeal Metacarpal Malunion/Nonunion 733.81

synonyms:

Phalangeal Malunion / Nonunion ICD-9

• 733.81 Malunion of fracture
• 733.82 Nonunion of fracture

Phalangeal Malunion / Nonunion Etiology / Epidemiology / Natural History

Phalangeal Malunion / Nonunion Anatomy

Phalangeal Malunion / Nonunion Clinical Evaluation

• Evaluate finger cascade with flexion. Any overlaps/scissoring indicates malunion. Always compare to normal hand.
• Evaluate any joint stiffness / adhesions or instability.

Phalangeal Malunion / Nonunion Diagnositc Tests

• A/P, lateral and oblique xrays. Consider xrays of normal contralateral digit for comparison.
• CT scan with 3-D reconstruction should be consider for intra-articular deformity.

Phalangeal Malunion / Nonunion Classification / Treatment

• Treatment is based on the amount of functional deficit and associated pathology. Middle and distal phalangeal lesions often have little functional deficit and may not require treatment. Proximal lesions often lead to functional deficit requiring treatment.

Phalangeal Malunion / Nonunion Phalanx Malunion Osteotomy and ORIF

• Pre-operative considerations: template osteotomy and fixation based on pre-operative films. Ensure mini-fragment set and C-arm are available.
• Pre-operative antibiotic.
• Position: supine with hand table
• Anesthesia: GETA or regional (axillary, supraclavicular block)
• Midaxial skin incision (allows exposure to deformity as well as flexor and extensor tendons in the case of associated adhesions).
• Osteotomy type depends on skeletal deformity. Proximal phalangeal angular deformity = incomplete opening wedge osteotomy. Rotational deformity = transverse osteotomy. Complex deformity (angular and rotational deformities) = oblique osteotomy in the plan of maximal deformity. Consider placing perpendicular K-wires proximal and distal to osteotomy site to aid in assessment of reduction.
• Fixation depends on bone size, need for stability and or associated bone grafts. Generally 2.0mm plates for the proximal phalanx, 2.4mm plates for metacarpals. Condylar plates are generally used for metaphyseal deformities.
• Perform any needed tenolysis and/or capsulectomies.
• Irrigate
• Close in layers.

Phalangeal Malunion / Nonunion Associated Injuries / Differential Diagnosis

• Stiffness

Phalangeal Malunion / Nonunion Complications

• Stiffness
• Loss of reduction
• Malunion

Phalangeal Malunion / Nonunion Follow-up Care

• Follow-up at 48-72 hours. Begin mobilization and occupational therapy. Consider Coban wraps and buddy taping for support.
• 96% excellent and good results in patients who had corrective osteotomies for malunion involving only the bone. (Buchler U, J Hand Surg 1996;21:33)

Phalangeal Malunion / Nonunion Review References

Jupiter JB in Master's Techniques: The Hand 2nd Ed, 2005:85