Executive Editor: Chris Colton

Authors: Fiesky Nuñez, Renato Fricker, Matej Kastelec, Terry Axelrod

Proximal phalanx - Distal metaphyseal (head), oblique

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Glossary

General considerations

Fractures of the distal metaphysis can be transverse, oblique, or comminuted.

Stable undisplaced fractures can be treated nonoperatively. Any displacement or instability will usually require ORIF.
Other indications for ORIF are open fractures, or soft-tissue lacerations. In these cases, ORIF is the best option.

Nonoperative treatment
Main indication Skill Equipment
Minimally displaced and/or stable Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Open fractures
  • Rotationally unstable fractures
Lag screw fixation
Main indication Skill Equipment
Rotationally unstable fractures and open fractures with longer obliquity Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Grossly contaminated wound
Lag screw with protection plate
Main indication Skill Equipment
Rotationally unstable fractures and open fractures with short obliquity Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Grossly contaminated wound
Minicondylar plate with lag screw
Main indication Skill Equipment
Rotationally unstable fractures and open fractures with short obliquity Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Grossly contaminated wound
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2008-11-08