Pediatric emergency medicine trisk 3348 3348
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Most middle phalanx injuries are managed by closed management, although
surgical reduction and stabilization may be required in displaced fractures.
Fractures of the head of the phalanx require close management by a hand
specialist because of a high rate of complications. Avulsion fractures of the
middle phalanx at the insertion of the volar plate or extensor central slip are
common. Avulsions on the volar side generally are from hyperextension. Often,
the fragment does not reattach. Prolonged immobilization may result in chronic
stiffness and has potential for permanent loss of range of motion. Splinting is
performed initially, but early range of motion is often started a week later. Small
avulsions on the extensor side are treated similarly, though larger fragments are
treated with longer splinting, and injuries with displaced and larger fracture
fragments with articular involvement may require open reduction ( Fig. 109.9 ).
