Phalangeal Shaft Fracture 816.00

synonyms: phalanx fracture

Phalangeal Shaft Fracture ICD-9

• Unspecified = 816.00 (closed), 816.10(open)
• Proximal or middle phalanx = 816.01(closed), 816.11(open)
• Distal phalanx = 816.02(closed), 816.12(open)
• Multiple sites = 816.03(closed), 816.13(open)

Phalangeal Shaft Fracture Etiology / Epidemiology / Natural History

• Common injury

Phalangeal Shaft Fracture Anatomy

• DIP extension is provided by the the conjoined lateral bands which insert into the base of the distal phalanx
• Conjoined lateral bands are made up of the lateral slips of the extrinsic extensor tendon and the lateral bands from the intrinsic interosseous and lumbrical muscles.
• DIP flexion is provided by FDP insertion into the volar base. Injury to the FDP at this level results in a Jersey Finger.
• See Hand Anatomy.

Phalangeal Shaft Fracture Clinical Evaluation

• Evaluate finger cascade with flexion. Any overlaps of injured digits indicates need for reduction +/- fixation.

Phalangeal Shaft Fracture Xray

• P/A, lateral abd oblique views of affected finger

Phalangeal Shaft Fracture Classification / Treatment

• Undisplaced (>2mm translation, >20 degrees angulation, no clinical deformity): Treatment = static or dynamic splinting (buddy taping). Follow weekly initially to ensure reduction is maintained (Maitra A, J Hand Surg 1992;17Br:332).
• Displaced transverse or short oblique: may be stable after reduction. If stable apply static splint in functional position for 4-6weeks. Unstable = CRPP vs ORIF. Consider transcutaneous mini-screws.
• Displaced Long oblique = Almost always unstable = CRPP(CPT=26727). Consider transcutaneous mini-screws. ORIFif fails closed reduction.
• Open fracture: consider mini-external fixation. (Freeeland AE, CORR, 1987;214:93)

Phalangeal Shaft Fracture Associated Injuries / Differential Diagnosis

• Phalangeal Base Fracture
• Phalangeal Neck Fracture
• Distal Phalanx Fracture
• Mallet finger

Phalangeal Shaft Fracture Complications

• Loss of reduction
• Delayed union
• Malunion
• Nonunion
• Tendon adhesion / stiffness
• Nerve or vascular injury

Phalangeal Shaft Fracture Follow-up

• Post-op /Initial: Place in alumifoam extension / clamshell. Elevation.
• 7-10 Days: xray to ensure reduction is maintained. Continued splint, activity modifications. Immobilize as few joints as necessary.
• 6 Weeks: Remove k-wire, wean from splint use as soon as callus is visible on xray. Continue activity modifications. Agressive DIP ROM.
• 3 Months: Resume full activities. Assess ROM. May require flexor/extensor tendon tenolysis to regain motion.
• 1Yr: assess outcomes / follow-up xrays.

Phalangeal Shaft Fracture Review References

• Freeland AE, Geissler WB, Weiss AP, Operative Treatment of Common Displaced and Unstable Fractures of the Hand, JBJS 2001;83A:928-945
• Freeland AE, Orbay JL. ORIF of the Tubular Bones of the Hand In: Stickland JW, Grahma TJ, editor. Hand 2nd ed. Master Techniques in orthopedic surgery. Philadeplhia: Lippincott-Raven; 2004. p 3
• Rockwood and Greens
• Greens Hand Surgery