Proximal phalanx: Articular, bicondylar

 Indications

Bicondylar fractures of the head of the proximal 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 for all displaced intra-articular fractures, when the skills and resources are available
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 nonoperative treatment is attempted, secondary displacement is likely, leading to angulation of the finger.

Caveat
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.

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v1.0 2008-11-08