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Principles

Bicondylar fractures of the head of the middle phalanx may be T-shaped, with a long, or a short, T.

Indications

Bicondylar fractures of the head of the middle phalanx may be T-shaped, with a long, or a short, T.
Another pattern of fracture is a combination of a long oblique fracture separating one condyle, together with a short oblique, or transverse, fracture separating the other condyle (sometimes called “reversed lambda” fractures, because of their resemblance to the Greek letter “λ“).
Lag screw fixation is indicated both for the short T-shaped and the reversed lambda fractures.
Typically these fractures are the results of sports injuries, due to axial load combined with lateral angulation of the finger.
Condylar fractures tend to be very unstable and should be treated operatively. If conservative treatment is attempted, a secondary displacement is likely, leading to angulation of the finger.
Outcome of fractures of the middle phalanx is usually more favourable than in the proximal phalanx. This is largely due to the fact that limitations in DIP joint motion is not as great a problem as similar limitations in the PIP and MCP joints.
However, since fragments in this segment are generally smaller than in the proximal phalanx, management and stabilization can be more of a challenge.
Consequences of malunion (pain or deformity), or of degenerative joint disease, at the DIP joint can well be dealt with by arthrodesis, which is a procedure with very predictable outcome.