Hand Cases to Consider.

Last updated Friday, February 11, 2005

Case 3

Case 3 - Treated

Answer to case 3

Diagnosis: Unicondylar phalanx fracture

Condylar phalanx fractures are frequently associated with sporting activities, as in this case. In 1971 London classified these fractures into 3 groups:

• Type I Nondisplaced stable fractures
• Type II Unicondylar unstable fractures
• Type III Bicondylar

Some argued that in reality there were very few type I fractures and that condylar fractures should be regarded as unstable. In 1993 Weiss and Hastings reported on 38 unicondylar fractures. They proposed the following classification:

• Class I Oblique palmar pattern. The plane of the fracture resides in neither the sagittal nor the coronal planes. The distal fracture fragment lies palmar to the proximal phalangeal shaft
• Class II Long oblique fracture line with the plane of the fracture sagittally oriented
• Class III Dorsal coronal fragment
• Class IV Palmar coronal fragment

In their patient group they had 7 nondisplaced fractures that were treated initially with splinting. 5 of these later displaced and needed surgical treatment. 4 of 10 fractures treated with a single k-wire fixation displaced. The authors recommended treatment was multible k-wires or miniscrew fixation.

Our case is a class I unicondylar fracture (see image with arrow at the proximal fracture line). He was treated with an open reduction and a single miniscrew (see image). We will usually try to reduce the fracture closed and pin it with k-wires. After getting 2 k-wires across the fracture, then one k-wire is changed over to a miniscrew. Here is a conversion table for k-wires to miniscrew:

References

London PS: Sprains and fractures involving the interphalangeal joints. Hand 3:15-8, 1971

Weiss AC, Hastings II H: Distal unicondylar fractures of the proximal phalanx. J Hand Surg 18A:594-9, 1993.

Disclaimer

This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.

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