INTRAARTICULAR IMPACTION FRACTURES OF THE PHALANGES

Six patients with acute impacted fractures of the base of the proximal or middle phalanges were treated with open reduction and internal fix ation. Two of three patients who presented with chronic injuries also underwent surgical reconstruction. Contiguous 1.5-mm sagittal computed tomographic imaging was performed on each proximal interphalangeal jo int fracture; the imaging documented an average impaction of 30% of th e articular surface area. Metaphyseal bone grafting was necessary to s upport the articular surface in three acute and both late patients. Ri gid internal fixation, most frequently employing a composite wire tens ion band technique, allowed immediate postoperative range of motion ex ercises. At an average follow-up period of 21 months, all six acute pa tients had restoration of an excellent painless range of motion. There was no loss of articular congruency on final x-ray films. Late or con servative treatment of these injuries was uniformly less successful.