Davos Courses

Executive Editor: Chris Colton

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

Distal phalanx - Distal & shaft, multifragmentary

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Glossary

General considerations

Fractures of the distal phalanx are the most common fractures in the hand.

In comminuted crush injuries, treatment of the fracture is of secondary importance. More important is soft-tissue management, i.e. of the pulp and of the nail matrix.

Multifragmentary fractures of the distal phalanx will often heal without complications due to the intrinsic stability provided by the soft tissues. The nail matrix, lateral interosseous ligaments and the fibrous septa are the main stabilizing structures. Therefore, simple splinting often provides adequate stability after soft-tissue repair.

Unstable, or displaced, fractures should be fixed internally with 1 or 2 K-wires, in order to prevent subsequent malunion, nonunion, or other complications such as nail deformity. A nail plate base, if avulsed, should be replaced deep to the eponychium – this helps to hold the fracture in reduction.

Nonoperative treatment
Main indication Skill Equipment
Stable, undisplaced, and closed fracture Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Open fractures
K-wire fixation
Main indication Skill Equipment
Unstable, comminuted, or open fractures Some specialized surgical experience Basic equipment only

Contraindications

  • Grossly contaminated injuries
*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

v2.0 2016-06.30