Highlights of Hand - Middle phalanges

Publication of second edition on April 22, 2025

The content has been revised by Aida García (CO) with Simon Lambert (UK) as executive editor. Inese Breide (LV) acted as a reviewer.

Visit the module entry page here!

$AP and lateral x-rays showing a long partial articular fracture of the 4th middle phalangeal head$

Author’s comments (Aida Garcia)

The hand – our best work, communication, and expression tool – requires a detailed study of the anatomy to apply all the surgical techniques described. The main goal of treating hand injuries is to recover its pinch and grip function. To achieve this, the management of soft tissues is essential to avoid fibrosis and/or stiffness.

Editor’s comments (Simon Lambert)

The hand, complementing visual expression and language as our means of communication and as the tool through which we interact with the environment, comprises simple, repeating units combined as a system of sensate levers bringing the palmar sensory receptors of the fingers into optimal relation with the object of the visual attention.

The hand also functions as a load bearing platform: during power grip (involving the whole hand), and pincer or tripod grip (involving mainly the radial column of the hand) the intracarpal relationships change, guided and limited by the intercarpal ligaments, to distribute the resultant load to the radius and ulna at the distal forearm. This adjustment brings the carpal bones into an energy-efficient interosseous-stable state of ‘close-packing’, permitting load-transfer with minimal effort from the brachio-(meta)carpal muscles.

This edition of the middle phalangeal module addresses the challenges of internal fixation of the fractures and associated ligament injuries that often result in decrements – of sensibility or activity – caused by malalignments and instabilities.

New information is offered about current trends including dynamic external fixation and updated rehabilitation programs.