2/19/2024 0 Comments Closed fracture reductionApex volar angulation occurs if the fracture is distal to the flexor digitorum superficialis insertion. Middle phalanx fractures occur in an apex dorsal or volar angulation depending on location. Apex dorsal angulation results from the fracture occurring proximal to the flexor digitorum superficialis (FDS) insertion so that the fragment becomes displaced by the pull of the central slip. Hyperflexion is usually the mechanism of injury and it presents as a mallet deformity with apex dorsal. Seymour fractures: this is a displaced epiphyseal injury of the distal phalanx associated with nail bed injury. This important anatomic relationship can lead to a swan neck deformity (a hyperextended PIPJ and flexed DIPJ). As the tendons transverse the PIPJ the flexor digitorum superficialis bifurcates into two slips that form the Camper's chiasm which inserts on the volar aspect of the middle phalanx. The flexor digitorum superficialis is volar, and the flexor digitorum profundus is dorsal. At the proximal interphalangeal joint (PIPJ), the flexor digitorum profundus and the flexor digitorum superficialis are within one sheath. The flexor digitorum profundus (FDP) inserts at the volar metaphysis of the distal phalanx. The distal phalanx anatomy includes the distal interphalangeal joint (DIPJ), which is enveloped by the extensor and flexor tendons along with the volar plate and collateral ligaments. The middle phalanx has two main insertions: the central slip (extensor mechanism) and the flexor digitorum superficialis (FDS). The proximal phalanx receives stabilization from the surrounding anatomy, including proper and accessory collateral ligaments, volar plate, and extensor/flexor tendons. The distal phalanx divides into the tuft, shaft, and base. The proximal and middle phalanges of the hand all possess a head, neck, shaft, and base. Early intervention is vital to allow healing and return of function. For the vast majority of phalanx fractures, an acceptable reduction is manageable with non-operative treatment. Injuries can occur at the proximal, middle, or distal phalanx. Phalangeal fractures of the hand are a common injury that presents to the emergency department and clinic.
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