Anatomic reduction of the articular surface is of paramount importance for successful surgical management and future comfort. Failure to properly reduce the fractures and create friction between the fracture components will load the cortex screws in bending, leading to implant breakage. Failure to reconstruct the articular surface will lead to osteoarthritis and lameness.
Reconstruction of the bony column of the proximal phalanx preserves limb length, promotes load sharing between the bone fragments and implants, and improves comfort. Generally, only fractures with at least one intact strut of bone extending from joint to joint are amendable to internal fixation with screws. Reconstruction then starts with the fragments comprising the proximal articular surface.