Clinical Example: Proximal phalanx bicondylar oblique volar coronal head fracture

This gentleman sustained a closed severe torsional injury of the right ring finger.

 
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Xrays show a complex intraarticular fracture of the proximal phalanx head. There is a displaced spiral oblique longitudinal fracture with a second oblique coronal split through the articular surface of the radial condyle.
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Palmar displacement of a portion of one condyle is visible on the lateral view.
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The heads of the proximal and middle phalanges have a complex double wheel (condyle) contour,similar to that of the knee. Motion requires proper three dimensional alignent of all surfaces:
This fracture was exposed through a volar approach similar to that used for a volar plate arthroplasty.
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A possible "Y" access is planned here as the dotted line.
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The proximal phalanx head was in two main fragments, separated by a spike of bone from the proximal shaft. Flexor tendons are retracted here with a small Penrose drain.
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Contusion of the ulnar condyle.
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The joint was reconstructed with 1.0mm screws and the shaft fixed with 1.3mm screws using the Synthes titanium modular hand tray.
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Intraoperative fluoroscopy.
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Six months after surgery:
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