Release notes of Hand - Proximal phalanges

The content has been revised by Aida García (CO) and Fabio Suarez (CO) with Simon Lambert (UK) as executive editor.

The main differences to the first edition are:

• Update of plating procedures to VA locking plates
• Management of metacarpophalangeal joint dislocation

Pages on the following topics have been added:

• Nonoperative treatment to most of the fracture types
• K-wire fixation to most of the fracture types
• Intramedullary screw fixation to transverse fractures
• External fixation to multifragmentary shaft fractures

Several approach and procedure videos have been added:

• Dorsal approach to the proximal phalanx
• Dorsal approaches to the proximal interphalangeal joint
• Midaxial (lateral) approach to the proximal phalanx
• Volar approach to the metacarpophalangeal joint
• Mini external fixator
• Bicondylar fracture fixation using a 1.5 mm variable angle locking phalangeal head plate

The proximal phalangeal material of the hand, second edition, includes a detailed description of the following injury types and their management.

Avulsion at the proximal end segment:

• Nonoperative treatment
• K-wire fixation
• Cerclage compression wiring
• Collateral ligament reattachment
• Lag-screw fixation

Partial articular fracture of the proximal end segment:

• Nonoperative treatment
• K-wire fixation
• Cerclage compression wiring
• Lag-screw fixation

Complete articular fracture of the proximal end segment:

• Nonoperative treatment
• Plating with a lateral plate
• Plating with a dorsal T-plate

Oblique extraarticular fracture of the proximal end segment:

• Nonoperative treatment
• K-wire fixation
• Lag-screw fixation
• Lag-screw fixation with a neutralization plate
• Compression with a lateral plate with/without a lag screw
• Compression with a dorsal T-plate with/without a lag screw

Transverse extraarticular fracture of the proximal end segment:

• Nonoperative treatment
• K-wire fixation
• Compression plating with a lateral plate
• Compression plating with a dorsal T-plate
• Intramedullary screw fixation

Oblique fracture of the diaphysis:

• Nonoperative treatment
• K-wire fixation
• Lag-screw fixation
• Lag-screw fixation with a neutralization plate
• Compression plating

Transverse fracture of the diaphysis:

• Nonoperative treatment
• Compression plating
• Intramedullary screw fixation

Wedge/multifragmentary fracture of the diaphysis:

• Nonoperative treatment
• Lag-screw and plate fixation
• Bridge plating
• External fixation

Oblique extraarticular fracture of the distal end segment:

• Nonoperative treatment
• K-wire fixation
• Lag-screw fixation
• Lag-screw fixation with a neutralization plate
• Compression with a lateral plate with/without a lag screw
• Compression with a dorsal T-plate with/without a lag screw

Transverse extraarticular fracture of the distal end segment:

• Nonoperative treatment
• K-wire fixation
• Compression plating with a lateral plate
• Intramedullary screw fixation

Wedge/multifragmentary extraarticular fracture of the distal end segment:

• Nonoperative treatment
• Bridge plating

Partial articular fracture of the distal end segment:

• Nonoperative treatment
• K-wire fixation
• Cerclage compression wiring
• Collateral ligament reattachment
• Lag-screw fixation
• Lag-screw fixation with a neutralization plate

Complete articular fracture of the distal end segment:

• Nonoperative treatment
• Lag-screw fixation
• Plating with a lateral plate
• Plating with a dorsal T-plate

Dislocation and fracture-dislocation of the distal end segment:

• Nonoperative treatment
• Collateral ligament repair
• K-wire fixation
• Lag-screw fixation

Approaches:

• Dorsal approach to the metacarpophalangeal joint
• Dorsal approach to the proximal phalanx (after Pratt)
• Dorsal approaches to the proximal interphalangeal joint
• Midaxial (lateral) approach to the proximal interphalangeal joint
• Midaxial (lateral) approach to the proximal phalanx
• Palmar approach to the proximal interphalangeal joint
• Volar approach to the metacarpophalangeal joint

Further material:

• Patient assessment
• Patient positioning
• Complications and technical failures
• References

The content has been created by Renato Fricker (CH), Matej Kastelec (SI), Fiesky Nuñez (VE), and Terry Axelrod (CA) with Chris Colton (UK) as executive editor.

The proximal phalangeal material of the hand, first edition, included a detailed description of the following injury types and their management.

Distal articular, oblique:

• Nonoperative treatment
• Lag screw fixation

Distal articular, unicondylar fracture dislocation:

• Lag screw fixation

Distal articular, bicondylar:

• Lag screw fixation

Distal metaphyseal (head), transverse:

• Minicondylar compression plate fixation

Distal metaphyseal (head), oblique:

• Nonoperative treatment
• Lag screw fixation
• Lag screw with protection plate
• Minicondylar plate with lag screw

Distal metaphyseal (head), multifragmentary:

• Nonoperative treatment
• Minicondylar bridge plate fixation

Shaft, transverse:

• Nonoperative treatment
• Compression plate fixation

Distal metaphyseal (head), oblique:

• Nonoperative treatment
• Lag screw fixation
• Lag screw with protection plate
• Minicondylar plate with lag screw

Shaft, multifragmentary:

• Nonoperative treatment
• Bridge plate fixation of oblique wedge fractures
• Bridge plate fixation of multifragmentary fractures

Proximal metaphyseal, transverse:

• Nonoperative treatment
• Minicondylar plate fixation
• T-plate fixation

Proximal metaphyseal, oblique:

• Nonoperative treatment
• Lag screw fixation
• Minicondylar compression plate fixation
• T-compression plate fixation

Proximal articular, avulsion:

• Tension-band wiring
• Collateral ligament reattachment
• Lag screw fixation

Proximal articular, shearing:

• Lag screw fixation

Proximal articular, multifragmentary:

• Minicondylar bridge plate fixation
• T-plate fixation

Approaches:

• Midaxial approach to the proximal phalanx
• Dorsal approach to the phalangeal metaphysis (after Pratt)
• Dorsal approaches to the PIP joint
• Palmar approach to the PIP joint
• Midaxial approach to the PIP joint

Further reading:

• References