Proximal phalanx, metaphyseal (head), oblique
Indications
Fractures of the distal metaphysis can be transverse, oblique, or comminuted.
Always confirm the fracture configuration in views from both planes.
Stable undisplaced fractures can be treated nonoperatively. Any displacement or instability will usually require ORIF.
Other indications for ORIF are open fractures, or soft-tissue lacerations. In these cases, ORIF is the best option.
Reduction principles
Indirect reduction is achieved by traction and manipulation.
These oblique fractures are likely to be unstable after reduction, especially long fractures, and in such cases, ORIF is indicated.
Sometimes indirect reduction may be prevented by interposition of the lateral band.
If the fracture is irreducible, ORIF is indicated.
