Bicondylar fractures of the head of the middle phalanx may be T-shaped, with a long, or a short, T.
Another pattern of fracture is a combination of a long oblique fracture separating one condyle, together with a short oblique, or transverse, fracture separating the other condyle (sometimes called “reversed lambda” fractures, because of their resemblance to the Greek letter “λ“).
Lag screw fixation is indicated both for the short T-shaped and the reversed lambda fractures.
Typically these fractures are the results of axial load combined with lateral angulation of the finger.
Bicondylar fractures tend to be very unstable and should be treated operatively. If conservative treatment is attempted, secondary displacement is likely, leading to angulation of the finger.
These fractures are rare, but difficult to treat. There is an increased risk of joint stiffness resulting from these fractures.
It is wise to use magnifying loupes in these procedures. Gentle and precise handling throughout the procedure is mandatory.