Phalangeal Fractures

Phalangeal fractures are usually stable due to the adhering soft-tissue envelope. The diaphysis is thicker on the radial and ulnar borders than on the anterior/posterior borders. This thickening is continued laterally by osteocutaneous ligaments called Cleland's and Grayson's ligaments. These ligaments anchor the bone at the mid-portion of the diaphysis and stabilize the bony shaft to the envelope. Occasionally these structures can become trapped in the fracture site and prevent reduction of the fracture. The flexor and extensor tendons provide both stability and induce deforming forces. The flexor tendons are stronger and can cause a dorsal angulation of the fracture. Healing in this position can result in the extensor tendons being weakened and functioning with an extensor lag. The extensor tendons can also

Figure 41-6 Radiograph of a first metacarpal fracture (Bennett fracture).

cause a volar angulation of the bone, which will limit flexion of the digit.

It is important to remember that fractures of the proximal phalanx displace with volar angulation. The proximal fragment is flexed by the bony insertion of the interossei into the base of proximal phalanx. The distal fragment is pulled into hyperextension by the central slip through the PIP joint.

Base of the Proximal Phalanx Fractures

Fractures at the base of the proximal phalanx usually occur in a transverse direction with dorsal impaction and apex volar angu-lation. This fracture is seen more commonly in teenagers. It can usually be treated with an orthosis in the safe position; however, fracture instability can occur. Burkhalter25 described an immobilization method whereby the MCP joint is flexed and active motion of the PIP joint is allowed. For unstable fractures, the use of closed reduction percutaneous pinning, open reduction with internal fixation with screws or a plate and screws or external fixation is often used. In displaced fractures, the finger will rest in the position of abduction.26 Of surgical importance, it is often difficult to place pins in the proximal phalanx from a distal to proximal direction. However, it is much easier to place the pins from a proximal to distal direction through the dorsal portion of the metacarpal head into the proximal phalanx frac-ture.13 This aids in maintaining the metacarpal phalangeal joint in the safe position (30 to 40 degrees of flexion). Immediate

Figure 41-7 A, Radiograph of a fifth metacarpal fracture (baby Bennett fracture). B, Radiograph after reduction.

Figure 41-7 A, Radiograph of a fifth metacarpal fracture (baby Bennett fracture). B, Radiograph after reduction.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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