Treatment of Oblique Displaced Proximal Phalanx Fracture of the Finger
For an oblique displaced proximal phalanx fracture, surgical fixation is recommended when displacement exceeds 3mm, with open reduction and cerclage wire fixation being the preferred technique for long oblique/spiral patterns, allowing immediate joint mobilization to optimize functional outcomes.
Initial Assessment and Imaging
- Obtain three-view radiographs (posteroanterior, lateral, and oblique) to properly evaluate fracture pattern, displacement degree, and articular involvement 1
- Two-view radiography is inadequate for detecting all fracture characteristics 1
- Examine finger alignment during active flexion by having the patient make a fist to detect malrotation 1
- Scissoring (finger crossing over or under adjacent digit) indicates rotational malalignment requiring immediate surgical intervention 1
Surgical Indications
Refer for surgical treatment if any of the following are present:
- Fracture displacement >3mm 1
- Interfragmentary gap >3mm 1
- Involvement of more than one-third of the articular surface 1
- Any malrotation detected on clinical examination 1
- Unstable fracture pattern 2, 3
Surgical Technique for Oblique/Spiral Fractures
- Open reduction with cerclage wire fixation is the optimal technique for long oblique/spiral proximal phalanx fractures 4
- This approach allows immediate postoperative mobilization of all joints (metacarpophalangeal and interphalangeal), which significantly improves outcomes 4, 5
- Cerclage wire fixation achieves union in all cases with minimal complications (infection rate <5%, no wire migration or complex regional pain syndrome) 4
- Leaving the metacarpophalangeal and proximal interphalangeal joints free to move immediately after surgery produces significantly better total active motion scores compared to techniques that immobilize these joints 5
Alternative Surgical Options
- Percutaneous K-wire fixation is technically easier and reliable for transverse fractures but produces inferior results when the metacarpophalangeal joint is immobilized 5, 3
- K-wire fixation that leaves joints free produces excellent-to-good results in 72% of cases 5
- Mini external fixators can be used for comminuted patterns 3
Conservative Treatment (Only for Specific Cases)
- Reserved for truly stable fractures with minimal displacement (<3mm) and no malrotation 1, 3
- Rigid immobilization in intrinsic-plus position for 3-6 weeks combined with immediate active interphalangeal joint motion exercises 1
- Conservative treatment produces excellent-to-good results in 89% of stable fractures but has higher malunion rates (8.5%) 3
Post-Treatment Monitoring
- Obtain repeat radiographs at 10-14 days to ensure fracture position is maintained 1
- Continue radiographic monitoring at 3 weeks and at cessation of immobilization 1
- Institute home exercise program with complete range of motion exercises to minimize stiffness 1
- Return to work typically occurs at 8 weeks post-surgery with cerclage wire fixation 4
Critical Pitfalls to Avoid
- Do not rely on buddy taping for displaced oblique fractures—this produces the poorest results 3
- Do not accept any degree of malrotation, as this causes permanent functional impairment 1, 2
- Avoid immobilizing the metacarpophalangeal joint if possible, as this significantly worsens total active motion outcomes 5
- Do not delay surgical referral for unstable patterns, as late presentation (>10 days) complicates fixation 4