Treatment of Fracture at the Base of the Fifth Middle Phalanx with Intra-articular Extension

Initial Assessment

Standard 3-view radiographic examination is the initial imaging modality of choice for suspected phalangeal fractures, according to the American College of Radiology, and includes PA, lateral, and oblique views 2, 3
An internally rotated oblique projection, in addition to the standard externally rotated oblique, increases diagnostic yield for phalangeal fractures, as recommended by the American College of Radiology 2
CT without IV contrast may be necessary when radiographs are equivocal to better evaluate intra-articular extension and displacement, as suggested by the American College of Radiology 4

Intra-articular extension with displacement >3mm or articular step-off is an indication for surgical intervention, according to the American College of Radiology 1
Fractures involving more than one-third of the articular surface require surgical fixation, as recommended by the American College of Radiology 2
Interfragmentary gap >3mm is an indication for surgical intervention, according to the American College of Radiology 2
Joint instability or incongruity requires surgical fixation, as recommended by the American College of Radiology 1

Dynamic External Fixation is preferred for unstable intra-articular fractures of the middle phalanx, according to the American College of Radiology 1
Arthroscopic-Assisted Reduction is useful for improved diagnostic accuracy and treatment of intra-articular fractures, as recommended by the American College of Radiology 1

Early active motion exercises should be initiated as soon as stability allows to prevent stiffness, according to the American College of Radiology 1
Radiographic follow-up at approximately 3 weeks and at the time of hardware removal to confirm adequate healing is recommended by the American College of Radiology 1

Joint stiffness is one of the most functionally disabling complications and can be minimized with early appropriate motion, according to the American College of Radiology 1
Immobilization-related complications occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy, as reported by the American College of Radiology 1
Without proper treatment, intra-articular fractures can lead to joint incongruity and subsequent arthritis, according to the American College of Radiology 1

Avoid conservative management with simple splinting for displaced intra-articular fractures, as this leads to poor outcomes and post-traumatic arthritis, according to the American College of Radiology 1
Avoid excessive immobilization, as this increases the risk of stiffness, as recommended by the American College of Radiology 1