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Executive Editor: Joseph Schatzker, Richard Buckley

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

Phalanges - Hallux, proximal phalanx, head, intraarticular

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Glossary

1 Nonoperative treatment top

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Nonoperative treatment involves manual reduction, buddy taping or a hard-sole shoe, until the fracture site is non-tender.

2 Closed reduction and K-wire fixation top

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When operative treatment is indicated, closed reduction and K-wire fixation is appropriate in most cases.

After manual reduction, one K-wire is placed to secure the fracture fragment perpendicular to the line of the fracture. A second K-wire is placed in the sagittal plane to maintain alignment of the hallux at the IP joint.


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This image shows the fracture treated with closed reduction and percutaneous K-wire fixation.

3 Open reduction internal fixation top

Approach

Intraarticular head fractures of the proximal phalanx of the hallux may be approached through a medial approach to the hallux.


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Irrigation

Irrigate the fracture. The displaced fracture fragment(s) is mobilized using a dental pick or Freer elevator.


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Reduction

The split wedge fragment is reduced with a small bone tamp or elevator, and held in position with pointed reduction forceps.


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Lag screw fixation

A 2.0 mm or 2.4 mm lag screw is placed through the fragment perpendicular to the fracture site by drilling the appropriate gliding and thread holes.

Use fully threaded screws for lag screws.

v2.0 2017-03-23