title: Condylar fractures of the proximal and middle phalanges.
abstract: We describe the treatment of 74 patients with phalangeal condylar fractures. Twelve patients presenting with undisplaced fractures were initially treated nonoperatively; of these, five displaced, requiring fixation. The remaining seven patients, all children, united uneventfully. Sixty-two patients presenting with displaced fractures were treated with internal fixation using a single lag screw through a lateral approach. The patients were treated semi-electively on a day surgery unit. Twenty-seven patients with unicondylar fractures, all operated on within 2 weeks of injury, regained full range of movement. Thirty-eight patients had loss of extension (range 10-35°) with fixed flexion contractures at the proximal interphalangeal and thumb interphalangeal joints and extensor lag at the distal interphalangeal joints (overall mean extension loss 10°). Although fixation was technically easier during the first week, a delay of 2 weeks before fixation made little difference to the outcome. In our experience, fractures can be taken down and fixed internally even 8 weeks after injury. If nonoperative treatment is initially embarked upon, close monitoring is required with weekly radiographs up to 3 weeks, as these fractures will frequently displace.
authors.affiliation: Department of Trauma & Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK davidshewring@me.com.
authors.forename: D J
authors.initials: DJ
authors.lastname: Shewring
authors.affiliation: Department of Trauma & Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Miller
authors.affiliation: Department of Trauma & Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ghandour
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D002648:Child; D005260:Female; D005384:Finger Joint; D050278:Finger Phalanges / Q000293:injuries*; D005593:Fracture Fixation, Internal; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Condylar fracture; internal fixation; lag screw; semi-elective