Fractures of the diaphysis can be transverse, oblique, spiral, or comminuted. Reduction is achieved by traction and digital manipulation. When the fracture is stable, it can be treated nonoperatively. If the fracture is irreducible, ORIF is indicated. Other indications for surgical fixation are open fractures, or associated soft-tissue lacerations. Outcome of fractures of the middle phalanx is usually more favourable that those of the proximal phalanx. This is largely due to the fact that limitations in DIP joint motion is not such a disability as similar stiffness of the PIP and MCP joints.
However, since the fragments in middle phalangeal fractures are generally smaller than in the proximal phalanx, fixation can be more challenging.
Percutaneous K-wire fixation is often used for transverse fractures of the middle phalangeal diaphysis.
The advantages are:
minimal soft-tissue lesion
However, there are some disadvantages which can sometimes be significant, such as: