distal phanlanx fracture, Rockwood

Ch. 24 Fx & dislocation of the hand
Fractures in Adults, Rockwood, 6th edition

Trade-off: stiffness or instability (mal or nonunion?)

Mechanism
Axial loading
．associated injury to carpus or upper limb

Others: isolated phalangeal injury
．crushing, trapping injury: associated soft tissue damage

Fracture reduction
．Gentle maneuver instead of forceful traction
．MP joint flexion: decreased flexor tendon force

Finger immobilization: 4 weeks, than active ROM

Local anesthesia
．NO BOSMIN
．add hyanluronic acid: enhance anesthesia, less local edema
．add 1cc 10% Bicarbonate: reduce acidity of lidocaine, less pain on injection

Bone loss in finger fracture
．Open fracture, gunshot injury
．Comminution and bone loss
．Temporary external fixation(固定distal part) or spacer
．Delayed grafting with corticocancellous iliac bone graft (more stable) or
cancellous bone graft

Distal phalanx fracture
．Tuft, Shaft, and base
．base: insertion of extensor & flexor tendon
．relative stable if fracture line distal to tendon insertion

Dorsal base fracture
．avulsion fracture VS shearing fracture
．avulsion: smaller fragment, fracture line perpendicular to tensile force
．shearting: larger fragment, > 20% joint involvement, fracture line perpendicular to joint line

Tuft fracture
．most: splinting
．concomitant of nail bed injury: pinning and repair of nail matrix

Shaft fracture
．pinning in widely displaced fracture, transverse

Dorsal base fracture
．>25% joint involvement: pinning
．extension blocking technique (DIP flexion, 1st pin for extension block of proximal fragment, reduce distal fragment, 2nd pin)
．0.045 inch K-wire
．ORIF：tension band wire, most stable in cadaveric study，but hardware complication was noted in clinical application