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Phalangeal Base Fracture S62.509A S62.609A 816.00

 

 

 

 

Phalangeal base fracture xray


Phalangeal base fracture closed reduction

 

 

 

 

 

synonyms: phalanx base fracture

Phalangeal Base Fracture ICD-10

Distal Phalanx Fracture - Right ICD-10
Middle Phalanx Fracture - Right ICD-10 
Proximal Phalanx Fracture - Right ICD-10

Distal Phalanx Fracture - Left ICD-10
Middle Phalanx Fracture - Left ICD-10 
Proximal Phalanx Fracture - Left ICD-10 

 

A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

Phalangeal Base 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 Base Fracture Etiology / Epidemiology / Natural History

Phalangeal Base Fracture Anatomy

Phalangeal Base Fracture Clinical Evaluation

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

Phalangeal Base Fracture Xray

  • P/A and lateral views of affected finger
  • 30-45 degree suppinated or pronated views

Phalangeal Base Fracture Classification / Treatment

  • Undisplaced, displaced unicondylar fx involving <25% of articular surface without joint subluxation/deformity: buddy taping
  • Displaced unicondylar: Closed reduction under c-arm guidance, generally requires pointed reduction forceps. Cannulated reduction forceps facilitates K-wire placement. ORIF if closed reduction fails (Tan V, JOT 2005;19:518)
  • Displaced Bicondylar: almost always unstable. CRPP. Generally joint is reduced and rixed with transverse k-wires placed parallel to joint surface. Metaphysis is then reduced and secured to the diaphysis with two K-wires inserted from the tip of each condyle proximally into the medullary canal distally. Also consider ORIF if closed recuction fails (Tan V, JOT 2005;19:518)
  • Open fracture: consider mini-external fixation. (Freeland AE, CORR, 1987;214:93)

Phalangeal Base Fracture CRPP Technique

  • Belsky MR, J Hand Surg 1984;9Am:725
  • 0.045 (1.1mm) K-wires generally used. Consider 0.062in(1.6mm) for larger bones(metacarpal); 0.035in(0.9mm) for smaller bones (pediatric fx).
  • Closed reduction under c-arm guidance.
  • one or more intramedullary or two crossed K-wires.
  • K-wires must not cross at the fracture site.
  • K-wires are left in until fracture callus in visible on xray. Usually 3-4 weeks

Phalangeal Base Fracture ORIF Technique

  • Mid-axial incision centered over fx

Phalangeal Base Fracture Associated Injuries

  • Adjacent phalanx or metacarpal fractures
  • Carpal fractures
  • fight bite (high risk of injection)
  • Phalangeal Shaft Fracture
  • Phalangeal Neck Fracture
  • Distal Phalanx Fracture

Phalangeal Base Fracture Complications

  • Flexion Contracture: see Hogan CJ, JAAOS 2006;14:524.
  • Loss of reduction
  • Delayed union
  • Malunion
  • Tendon adhesion / stiffness
  • Cold intolerance
  • Numbness
  • Abnormal nail growth
  • Nerve or vascular injury

Phalangeal Base Fracture Follow-up

  • Weekly follow-up until fracture callus is seen on xrays is indicated to ensure reduction is maintained
  • Advance to passive ROM / Buddy taping as soon as fracture allows.

Phalangeal Base 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