Executive Editor: Chris Colton

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

Proximal phalanx

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Glossary

Distal articular, oblique

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 PIP joint, open fractures Some specialized surgical experience Simple surgical and imaging resources

Distal articular, unicondylar fracture dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Lag screw fixation Displaced condylar fractures, palmar subluxation of the PIP joint, open fractures Some specialized surgical experience Simple surgical and imaging resources

Distal articular, bicondylar

Please select a treatment option:
Treatment Main indication Skill Equipment
Lag screw fixation Displaced and/or unstable bicondylar fractures Highly experienced and skilled surgeon Simple surgical and imaging resources

Distal metaphyseal (head), 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 with longer obliquity Some specialized surgical experience Simple surgical and imaging resources
Lag screw with protection plate Rotationally unstable fractures and open fractures with short obliquity Some specialized surgical experience Simple surgical and imaging resources
Minicondylar plate with lag screw Rotationally unstable fractures and open fractures with short obliquity Some specialized surgical experience Simple surgical and imaging resources

Distal metaphyseal (head), transverse

Please select a treatment option:
Treatment Main indication Skill Equipment
Minicondylar compression plate fixation Rotational or axial deformity, open fractures, associated soft tissue injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Distal metaphyseal (head), 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 fixation Rotational or axial deformity, open fractures, associated soft tissue injury Highly experienced and skilled surgeon Full specialized 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
Compression plate fixation Open fracture or gross displacement 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
Compression plate fixation Open fracture or gross displacement Highly experienced and skilled surgeon Simple surgical and imaging resources

Shaft, multifragmentary

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
Bridge plate fixation of oblique wedge fractures Rotationally unstable or axial unstable, open fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plate fixation of multifragmentary fractures Rotationally unstable or axial unstable, open fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Proximal metaphyseal, 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, long oblique, and open fractures Some specialized surgical experience Simple surgical and imaging resources
Minicondylar compression plate fixation Rotational or axial deformity, simple oblique, open fractures, associated soft tissue injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
T-compression plate fixation Rotationally unstable or axial unstable, simple oblique, open fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Proximal metaphyseal, transverse

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
Minicondylar plate fixation Rotationally unstable or axial unstable, open fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
T-plate fixation Rotationally unstable or axial unstable, open fractures Some specialized surgical experience Simple surgical and imaging resources

Proximal articular, avulsion

Please select a treatment option:
Treatment Main indication Skill Equipment
Tension-band wiring Significantly displaced fragment, and/or joint subluxation with smaller bone fragment, open fractures Some specialized surgical experience Simple surgical and imaging resources
Collateral ligament reattachment Instability of the joint, tiny or multifragmentary bony fragment Some specialized surgical experience Basic equipment only
Lag screw fixation Significantly displaced fragment, and/or joint subluxation with larger bone fragment, open fractures Some specialized surgical experience Simple surgical and imaging resources

Proximal articular, shearing

Please select a treatment option:
Treatment Main indication Skill Equipment
Lag screw fixation Axial instability, joint surface displacement Some specialized surgical experience Simple surgical and imaging resources

Proxmial articular, multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Minicondylar bridge plate fixation Angular deformity or articular incongruence Highly experienced and skilled surgeon Full specialized surgical and imaging resources
T-plate fixation Angular deformity or articular incongruence Highly experienced and skilled surgeon Full specialized 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