Executive Editor: Chris Colton

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

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Glossary

Distal phalanx: 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

Distal phalanx: 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

Distal phalanx: Base - 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

Distal phalanx: Base - 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

Distal phalanx: Base - 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

Proximal phalanx: Articular (head) - Oblique

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Undisplaced or minimally displaced (less than 1 mm) condylar fragment Basic surgical experience, no specialized skills Basic equipment only
Lag screw fixation Displaced condylar fractures, palmar subluxation of the PIP joint, open fractures Some specialized surgical experience Simple surgical and imaging resources

Proximal phalanx: Articular (head) - unicondylar fracture dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Lag screw fixation Displaced condylar fractures, palmar subluxation of the PIP joint, open fractures Some specialized surgical experience Simple surgical and imaging resources

Proximal phalanx: Articular (head) - bicondylar

Please select a treatment option:
Treatment Main indication Skill Equipment
Lag screw fixation Displaced and/or unstable bicondylar fractures Highly experienced and skilled surgeon Simple surgical and imaging resources

Proximal phalanx: Metaphyseal (head), oblique

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Minimally displaced and/or stable Basic surgical experience, no specialized skills Basic equipment only
Lag screw fixation Rotationally unstable fractures and open fractures with longer obliquity Some specialized surgical experience Simple surgical and imaging resources
Lag screw with protection plate Rotationally unstable fractures and open fractures with short obliquity Some specialized surgical experience Simple surgical and imaging resources
Minicondylar plate with lag screw Rotationally unstable fractures and open fractures with short obliquity Some specialized surgical experience Simple surgical and imaging resources

Proximal phalanx: Metaphyseal (head) - transverse

Please select a treatment option:
Treatment Main indication Skill Equipment
Minicondylar compression plate fixation Rotational or axial deformity, open fractures, associated soft tissue injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Proximal phalanx: Metaphyseal (head) - multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Well aligned phalanx without rotational or axial deformity Basic surgical experience, no specialized skills Basic equipment only
Minicondylar bridge plate fixation Rotational or axial deformity, open fractures, associated soft tissue injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Proximal phalanx: Base and shaft - Skiers thumb

Please select a treatment option:
Treatment Main indication Skill Equipment
Ligament reattachment with suture anchors Complete rupture of the ulnar collateral ligament Some specialized surgical experience Simple surgical and imaging resources

Proximal phalanx: Base and shaft - pilon fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Open reduction, internal fixation (ORIF) Articular incongruence, axial or rotational malalignment Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Proximal phalanx: Base and shaft - multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Bridge plate fixation Rotationally unstable or axial unstable, open fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Metacarpal: Base

Please select a treatment option:
Treatment Main indication Skill Equipment
External fixation Unstable comminuted fracture with deformity Some specialized surgical experience Simple surgical and imaging resources
Locking compression plate (LCP) fixation Displaced, angulated fracture with large articular segments Some specialized surgical experience Full specialized surgical and imaging resources

Metacarpal: Bennett fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Ability to achieve and maintain reduction with manipulation Some specialized surgical experience Basic equipment only
K-wire fixation Most displaced Bennett fractures Some specialized surgical experience Simple surgical and imaging resources
Lag screw fixation Most displaced Bennett fractures with a large medial fragment Highly experienced and skilled surgeon Simple surgical and imaging resources

Metacarpal: Rolando fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Nondisplaced fracture, well reduced fracture after manipulation Basic surgical experience, no specialized skills Basic equipment only
Plate fixation Most displaced Rolando fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

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

v1.0 2008-11-08