What is the treatment for an avulsion fracture of the articular surface of a phalanx?

From the Guidelines

Treatment for an avulsion fracture of the articular surface of a phalanx should prioritize operative fixation if involvement of more than one-third of the articular surface is present, or if there is palmar displacement of the distal phalanx or an interfragmentary gap of >3 mm, as indicated by radiographs 1. When evaluating patients with suspected finger injuries, radiographs are essential for detecting fracture fragments and determining the need for open reduction and internal fixation.

• For osseous “mallet” injuries, which include bony avulsion at the insertion of the extensor mechanism of the finger to the distal interphalangeal joint, radiographs are usually sufficient for evaluation.
• Involvement of more than one-third of the articular surface usually requires operative fixation, as does palmar displacement of the distal phalanx or an interfragmentary gap of >3 mm 1.
• A standard 3-view radiographic examination of the hand is typically adequate for detecting most fractures and dislocations of the metacarpals and phalanges, but additional views such as an internally rotated oblique projection may increase diagnostic yield for phalangeal fractures.
• The goal of treatment is to restore joint congruity and prevent long-term complications like joint instability, post-traumatic arthritis, and permanent loss of motion, emphasizing the importance of proper management of avulsion fractures of the articular surface of a phalanx.

From the Research

Treatment Options for Avulsion Fracture of Articular Surface Phalanx

• The treatment of avulsion fractures of the articular surface of the phalanx depends on various factors, including the size and location of the fracture, the condition of the soft tissue envelope, and the presence of associated injuries 2.
• In cases where the fracture fragment involves a significant portion of the articular surface, surgical treatment may be necessary to restore anatomy and preserve function 2, 3.
• Open reduction and internal fixation has been shown to be an effective treatment for large volar plate avulsion fractures of the base of the middle phalanx with significant displacement 4.
• The size and shape of the avulsed fragment may be important factors in determining the treatment method, with larger fragments potentially requiring fixation rather than excision 5.
• Nonoperative treatment, such as immobilization with splints, may be recommended for smaller fractures or those with minimal displacement 3.
• In cases where surgical treatment is necessary, careful soft tissue handling and early mobilization are crucial to achieve good postoperative outcomes 2, 6.

Indications for Surgical Treatment

• Surgical treatment is indicated for avulsion fractures involving at least one third of the articular surface, especially if there is palmar subluxation of the distal phalanx 3.
• Open injuries, failed splinting treatment, and fractures with significant displacement or rotational deformity may also require surgical intervention 3, 5.
• The goal of surgical treatment is to restore anatomy, preserve function, and minimize the risk of complications such as chronic pain, stiffness, and deformity 6.