Executive Editor: Chris Colton

Authors: Fiesky Nuñez, Renato Fricker, Matej Kastelec, Terry Axelrod

Middle phalanx

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Glossary

Distal, unicondylar

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Undisplaced or minimally displaced (less than 1 mm) condylar fragment Basic surgical experience, no specialized skills Basic equipment only
Lag screw fixation Displaced condylar fractures, palmar subluxation of the DIP joint, open fractures Some specialized surgical experience Simple surgical and imaging resources

Distal, bicondylar

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Totally nondisplaced condylar fragments Basic surgical experience, no specialized skills Basic equipment only
Lag screw fixation Displaced and/or unstable bicondylar fractures Highly experienced and skilled surgeon Simple surgical and imaging resources

Shaft, transverse

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Minimally displaced, stable fractures Basic surgical experience, no specialized skills Basic equipment only
K-wire fixation Open fracture or gross displacement Basic surgical experience, no specialized skills Basic equipment only
Compression plate fixation Open fracture or gross displacement Highly experienced and skilled surgeon Simple surgical and imaging resources

Shaft, oblique

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Minimally displaced and/or stable Basic surgical experience, no specialized skills Basic equipment only
Lag screw fixation Rotationally unstable fractures and open fractures Some specialized surgical experience Simple surgical and imaging resources

Shaft, multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Well aligned phalanx without rotational or axial deformity Basic surgical experience, no specialized skills Basic equipment only
Minicondylar bridge plate Rotational or axial deformity, open fractures, associated soft tissue injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Proximal, dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Collateral ligament repair Instability of the joint following closed reduction Some specialized surgical experience Basic equipment only

Proximal, dorsal avulsion fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Dorsal lag screw fixation Significantly displaced fragment, and/or joint subluxation, open fractures Some specialized surgical experience Simple surgical and imaging resources
Tension-band wiring Significantly displaced fragment, and/or joint subluxation, open fractures Some specialized surgical experience Simple surgical and imaging resources

Proximal, collateral ligament avulsion

Please select a treatment option:
Treatment Main indication Skill Equipment
Lag screw fixation Significantly displaced fragment, and/or joint subluxation, open fractures Some specialized surgical experience Simple surgical and imaging resources
Tension-band wiring Significantly displaced fragment, and/or joint subluxation, open fractures Some specialized surgical experience Simple surgical and imaging resources

Proximal, volar plate avulsion

Please select a treatment option:
Treatment Main indication Skill Equipment
Lag screw fixation of volar plate Joint instability with a moderate to large fragment, minimal fragmentation Some specialized surgical experience Simple surgical and imaging resources
Suture fixation Tiny volar fragment, essentially a soft tissue repair Some specialized surgical experience Basic equipment only
Volar plate arthroplasty Extensive fragmentation and impaction of the volar fragment with joint instability Some specialized surgical experience Basic equipment only

Proximal, multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Hemi-hamate arthroplasty with bone graft Extensive fragmentation and impaction of the volar fragment with joint instability, greater than 30% joint involvement Some specialized surgical experience Basic equipment only
Joint reconstruction with bone graft Joint impaction Highly experienced and skilled surgeon Simple surgical and imaging resources
Minicondylar plate fixation of Pilon compression fracture Articular surface and metaphyseal fragmentation with deformity Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Screw fixation of lateral plateau compression fracture Joint instability, articular surface incongruence Some specialized surgical experience Simple surgical and imaging resources
Screw fixation with bone graft of central impaction fracture Joint instability, articular surface incongruence Some specialized surgical experience Simple surgical and imaging resources

Special considerations

Principles of management of open fractures
Complications
Infection
Compartment syndrome
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2008-11-08