Executive Editor: Chris Colton

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

Distal phalanx

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Glossary

Distal and shaft, transverse

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Undisplaced closed fracture Basic surgical experience, no specialized skills Basic equipment only
K-wire fixation Displaced, unstable or open fracture Some specialized surgical experience Basic equipment only

Proximal, Dorsal avulsion

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Stable joint after reduction, minimal fragment displacement Basic surgical experience, no specialized skills Basic equipment only
K-wire immobilization Palmar subluxation of the DIP joint, very small dorsal fragment, open fractures Some specialized surgical experience Basic equipment only
Lag screw fixation Palmar subluxation of the DIP joint, moderate to large size dorsal fragment, open fractures Some specialized surgical experience Simple surgical and imaging resources
Tension-band wire Palmar subluxation of the DIP joint, moderate size dorsal fragment, open fractures Some specialized surgical experience Basic equipment only
K-wire fixation Palmar subluxation of the DIP joint, fragment large enough for K-wire fixation, open fractures Some specialized surgical experience Basic equipment only

Proximal, Palmar avulsion

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Stable joint after reduction Basic surgical experience, no specialized skills Basic equipment only
K-wire fixation Joint instability, disruption of the flexor tendon insertion, small bony fragment Basic surgical experience, no specialized skills Basic equipment only
Suture fixation Disruption of flexor tendon insertion, small bony fragment Basic surgical experience, no specialized skills Basic equipment only
Lag screw fixation Palmar subluxation of the DIP joint, open fractures, bony fragment large enough for screw fixation Some specialized surgical experience Simple surgical and imaging resources

Dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Stable joint after reduction Basic surgical experience, no specialized skills Basic equipment only
K-wire fixation Unstable DIP joint after closed reduction Basic surgical experience, no specialized skills Basic equipment only

Distal and shaft, multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Stable, undisplaced, and closed fracture Basic surgical experience, no specialized skills Basic equipment only
K-wire fixation Unstable, comminuted, or open fractures Some specialized surgical experience Basic equipment only

Special considerations
Principles of management of open fractures
Complications
Infection
Compartment syndrome
*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