Proximal phalanx, base and shaft, multifragmentary
The associated soft-tissue lesions carry the potential risk of edema, fibrotic reactions and eventual stiffness. For these reasons, these injuries are usually treated by ORIF, in order to provide sufficient stability for immediate mobilization, thereby reducing the risk of joint stiffness and tendon adhesions. Depending on the forces acting on the bone, two kinds of comminuted fractures are common: small fragment comminution, or wedge fractures.
Small fragment comminution
Even in the hand, which has a good blood supply, small fragment comminution is associated with poor soft-tissue attachments to the fragments and, thereby, compromised vascularity.
The degree and type of comminution depends on the forces and energy acting on the thumb. In some cases, a large wedge fragment may result from the injury. In such cases, vascularity is less likely to have been significantly compromised.