Executive Editor: Jörg Auer

Authors: Jörg Auer

Phalanges Distal phalanx, Multifragment

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Glossary

1 Principles top

Multifragement fracture of the distal phalanx enlarge

Special attention is given to compression of the articular fracture line. Extraarticular fractures can heal by second intention and are usually not fixed unless the fragments are big and there is enhanced intraoperative diagnostic imaging available.
If possible two screws are inserted.

2 Treatment top

Multifragement fracture of the distal phalanx enlarge

Screw fixation

The main articular fracture configuration is repaired by means of two 4,5 mm cortex screws inserted in lag fashion as described for the sagittal fractures.


Multifragement fracture of the distal phalanx enlarge

Fragment removal

If needed, the extensor process fragment can be removed under arthroscopic supervision.


Multifragement fracture of the distal phalanx enlarge

Filling the holes in the hoof wall

A small portion of a gentamycin-impregnated collagen sponge is inserted in each hole to fill the space between the surface of the distal phalanx and the hoof wall.


Multifragement fracture of the distal phalanx enlarge

The rest of the hole is filled with antibiotic-impregnated polymethylmethacrylate (PMMA). The edges are sealed with cyanoacrylate glue. If desired a Kevlar® strip can be glued over the top followed by non-adhesive tape covered.

v1.3 2013-11-20