Executive Editor: Joseph Schatzker, Richard Buckley

Authors: Michael Castro, Richard Buckley, Andrew Sands, Christina Kabbash

Phalanges - 2nd-5th row, proximal phalanx, head, intraarticular

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1 Patient positioning top


Supine position

The patient is placed supine on a radiolucent table. A well-padded bump is placed under the ankle and heel of the surgical foot to elevate the foot for improved access and stabilize against rotation.


The nonoperative leg is secured with safety straps or taping.

To correct for external rotation of the leg and foot, a well-padded bump may be placed under the ipsilateral hip (a).

Alternatively, to correct for internal rotation of the leg and foot, a well-padded bump is placed under the contralateral hip (b).

2 Nonoperative treatment top


Nonoperative treatment involves manual reduction, buddy taping and rigid-sole shoe until non-tender.

3 Closed reduction and K-wire fixation top


Operative treatment involves manual reduction and percutaneous pinning.

Manual traction is applied on the toe. A 1.25 mm or 1.6 mm K-wire is then placed into the tip of the toe just plantar to the nail, across the DIP and finishes in the proximal phalanx metaphyseal region proximally.

Fluoroscopic assistance during this procedure is necessary.

v2.0 2017-03-23