Unicondylar fractures of the middle phalanx can be transverse, short or long
oblique, or comminuted. Typically they are the results of a sports injuries,
caused by axial load combined with lateral angulation of the finger.
Condylar fractures tend to be very unstable and should usually be treated
operatively. If conservative treatment is attempted, secondary displacement,
leading to angulation of the finger, often ocurrs.
Short and long oblique fractures
Short oblique fractures typically originate in the intercondylar
Long oblique fractures more often originate through one of the condyles,
splitting proximally towards the diaphyseal cortex on the side of the uninjured
Outcome of fractures of the middle phalanx is usually more favourable than
in the proximal phalanx. This is largely due to the fact that limitation of DIP
joint motion is not as great a problem as similar limitations in the PIP and MP
However, since fragments in this segment are generally smaller than in the
proximal phalanx, management and stabilization can be more of a
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.
These fractures are rare, but difficult to treat. There is an increased
risk of joint stiffness resulting from these fractures.
It is wise to use magnifying loupes in these procedures. Gentle and precise
handling throughout the procedure is mandatory.