FRACTURES OF THE DISTAL INTERPHALANGEAL JOINT

Fractures at the distal interphalangeal joint present a therapeutic ch allenge to the hand surgeon because of the relatively small bones and joint surfaces involved and the limited internal fixation devices avai lable. Knowing which patients and which fractures are best treated sur gically is key to a successful result. The normal anatomy and biomecha nics of the joint are outlined and overviewed and the anatomy, etiolog y, therapy, and classification are discussed. Comminuted fractures of the articular surface of the distal phalanx are presented as are epiph yseal fractures of the distal phalanx. Avulsion of the profundus tenso n (jersey finger) is discussed, emphasizing Leddy and Packer's Types I , II, and III injuries and the recommended treatment. Condylar fractur es of the articular surface of the middle phalanx at the distal interp halangeal joint are the subject of the next section, with London's cla ssification scheme and recommended treatment. Finally, complex open in juries and replantation through the distal interphalangeal joint are p resented with guidelines for salvage and treatment.