1 Nonoperative treatment topenlarge
Nonoperative treatment involves manual reduction, buddy taping or a hard-sole shoe, until the fracture site is non-tender.
2 Patient preparation topenlarge
This procedure is normally performed with the patient in a supine position.
3 Closed reduction and K-wire fixation topenlarge
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.
This image shows the fracture treated with closed reduction and percutaneous K-wire fixation.
4 Open reduction internal fixation topenlarge
Intraarticular head fractures of the proximal phalanx of the hallux may be approached through a medial approach to the hallux.
Irrigate the fracture. The displaced fracture fragment(s) is mobilized using a dental pick or Freer elevator.
The split wedge fragment is reduced with a small bone tamp or elevator, and held in position with pointed reduction forceps.
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.