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Avulsion at the proximal end segment

 
 
 
 
 

Avulsion fractures result in marked joint instability.

If the fracture is not displaced and the joint is stable, nonoperative treatment is usually indicated.

Displaced unstable fractures must be stabilized with K-wires, a lag screw, or an intraosseous cerclage wire.

If the fracture is severely comminuted with multiple tiny fragments, it may be preferable to excise the fragments and reattach the collateral ligaments directly to the bone.

Avulsion fractures result in marked joint instability.

If the fracture is not displaced and the joint is stable, nonoperative treatment is usually indicated.

Displaced unstable fractures must be stabilized with K-wires, a lag screw, or an intraosseous cerclage wire.

If the fracture is severely comminuted with multiple tiny fragments, it may be preferable to excise the fragments and reattach the collateral ligaments directly to the bone.

Nonoperative treatment

Main indications

 
 
 

Small fragment (<10% of articular surface), stable joint

Advantages

  • Avoiding joint stiffness

Small fragment (<10% of articular surface), stable joint

Advantages

  • Avoiding joint stiffness

K-wire fixation

Main indications

 
 
 

Small fragment, young patient

Contraindications

  • Comminution

Advantages

  • Percutaneous (minimal soft-tissue damage)

Disadvantages

  • Does not provide compression (splint needed)
  • Risk of redisplacement
  • Risk of wire-track infection
  • Risk of non- or malunion

Small fragment, young patient

Contraindications

  • Comminution

Advantages

  • Percutaneous (minimal soft-tissue damage)

Disadvantages

  • Does not provide compression (splint needed)
  • Risk of redisplacement
  • Risk of wire-track infection
  • Risk of non- or malunion

Cerclage compression wiring

Main indications

 
 
 

Fragment >10% of articular surface

Further indications

  • Significantly displaced fragment
  • Joint subluxation with smaller bone fragment
  • Open fractures

Contraindications

  • Extensive wound contamination
  • Comminution

Advantages

  • Limited soft-tissue disruption
  • Minimal risk of fragmentation
  • Early active motion

Disadvantages

  • Risk of joint stiffness
  • Prominent implant
  • Implant removal often necessary

Fragment >10% of articular surface

Further indications

  • Significantly displaced fragment
  • Joint subluxation with smaller bone fragment
  • Open fractures

Contraindications

  • Extensive wound contamination
  • Comminution

Advantages

  • Limited soft-tissue disruption
  • Minimal risk of fragmentation
  • Early active motion

Disadvantages

  • Risk of joint stiffness
  • Prominent implant
  • Implant removal often necessary

Collateral ligament reattachment

Main indications

 
 
 

Tiny or multifragmentary bony fragment, joint instability

Contraindications

  • Avulsed articular surface >10%

Disadvantages

  • Risk of imbalanced finger movement with inappropriate reattachment
  • Risk of joint stiffness

Tiny or multifragmentary bony fragment, joint instability

Contraindications

  • Avulsed articular surface >10%

Disadvantages

  • Risk of imbalanced finger movement with inappropriate reattachment
  • Risk of joint stiffness

Lag-screw fixation

Main indications

 
 
 

Fragment >25% of articular surface

Further indications

  • Significantly displaced fragment
  • Open fractures

Contraindications

  • Extensive wound contamination
  • Fragment smaller than three times the screw head diameter

Advantages

  • Percutaneous screw insertion possible
  • Early active motion

Disadvantages

  • Risk of joint stiffness

Fragment >25% of articular surface

Further indications

  • Significantly displaced fragment
  • Open fractures

Contraindications

  • Extensive wound contamination
  • Fragment smaller than three times the screw head diameter

Advantages

  • Percutaneous screw insertion possible
  • Early active motion

Disadvantages

  • Risk of joint stiffness