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Phalangeal Fracture Fixation

63 citationsUpdated Sep 2026
Illustration: hand

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Internal fixation of phalangeal fractures aims to achieve stable anatomic restoration and early functional recovery [6]. This approach is a reliable method for fractures presenting with significant displacement, rotation, angulation, and/or instability [19]. Indications for screw fixation specifically include oblique and spiral fractures of the proximal phalanx, certain fractures with large single articular fragments involving the proximal interphalangeal joint, and appropriate Bennett's fractures [24]. Rigid internal fixation of basilar metaphyseal proximal phalangeal fractures by cancellous bone grafting alone is also feasible and produces rewarding results [30].

Multiple implant strategies provide effective stabilization. Miniature plates and screws are a possible choice for low-severity metacarpal and phalangeal fractures [4], while a low-profile titanium plate system is highly effective in maintaining anatomic reduction for comminuted metacarpal and phalangeal fractures [11]. Fixation using a titanium plate and screws through a midlateral approach is a reliable and safe method for most unstable proximal and middle phalangeal fracture types, associated with higher total active motion and fewer complications compared to Kirschner wires [29]. Evidence favors the lateral plating approach when fixing proximal phalanx fractures [22], although no differences in outcome were observed between dorsal and lateral plate fixation [1]. Both unicortical and bicortical locking screws provide sufficient stability to facilitate early motion without risk of clinically relevant displacement during plate fixation of midshaft proximal phalangeal fractures [14].

Intramedullary screw fixation is a safe and effective method for stabilizing extra-articular proximal phalangeal fractures in the short to medium term [26], providing stable fixation to allow early motion [3]. This technique is associated with good functional outcomes and a low complication rate [10], and intramedullary headless screw fixation could be considered as the current practice to treat extra-articular unstable fractures of metacarpals and phalanges, including complex cases [8]. Intramedullary screw fixation is also a viable option for extra-articular middle phalangeal fractures [17]. The use of proximally locked nails may safely extend indications to rotationally and longitudinally unstable fractures and minimizes the need for postoperative splinting in metacarpal fractures [18]. Phalanx fracture fixation with intramedullary hand nails may be beneficial as it has acceptable joint cartilage damage based on study data [15]. All six fingers treated with intramedullary fixation through a volar extra-tendon sheath approach obtained satisfactory union of the fractures, and no patient complained of pain at the final follow-up [7]. Closed reduction and percutaneous Kirschner-wire fixation by a joint sparing approach will yield good functional results with no or minimal complications in proximal phalangeal neck fractures [5], and closed reduction and percutaneous pinning using any of the presented techniques is an adequate method of treatment for unstable proximal phalanx fractures [21]. A minimally invasive technique for screw fixation of phalangeal finger fractures combines the advantages of percutaneous K-wire stabilisation with internal rigid fixation [16]. Screw fixation of distal phalanx fractures resulted in greater distal interphalangeal joint motion compared with K-wire fixation but required removal in half of cases [12]. Excellent outcomes were achieved after open reduction and internal fixation of proximal phalangeal fractures, providing a benchmark for recovery [2].

Anatomy & Pathophysiology

Bony Anatomy

The hand skeleton comprises 27 bones, 19 of which are long bones [54]. It is organized into five rays, each consisting of a metacarpal and phalanges [54]. The thumb ray includes a metacarpal and two phalanges, whereas the other four digital rays contain a metacarpal and three phalanges [54]. Epiphyseal plates are situated at the proximal ends of the phalanges and at the distal ends of the metacarpals, with the exception of the first metacarpal [54]. Regarding relative lengths, the proximal and middle phalanges of the middle and ring fingers are longer than those of the index finger [54]. The thumb metacarpal is the shortest metacarpal, while the index metacarpal is the longest [54]. A longitudinal groove runs the length of the phalangeal shaft [95]. Dorsally placed bicortical screws can protrude into this groove unnoticed on intraoperative imaging [95], potentially causing impingement on the flexor tendon [95].

Soft Tissue Anatomy

The extrinsic extensors traverse six fibroosseous retinacular compartments at the wrist [53]. Their principal bony insertion is on the dorsal proximal aspect of the middle phalanx [53]. Metacarpophalangeal joint extension relies on extrinsic extensor force transmitted through the sagittal bands [53]. Distal interphalangeal joint extension is achieved via conjoined lateral bands composed of tendinous slips from extrinsic and intrinsic tendons [53]. The sagittal band fibers insert onto the volar proximal phalanx and the lateral borders of the volar plate, forming a sling that transmits proximal extrinsic extensor tension to the proximal phalanx [53]. Rupture or attenuation of these fibers can cause the extrinsic extensor tendon to sublux to the ulnar side of the metacarpal head [53].

The flexor digitorum profundus inserts on the proximal volar aspect of the distal phalanx [53]. The flexor digitorum superficialis inserts via radial and ulnar slips into the proximal metaphysis of the middle phalanx [75]. The fibroosseous tunnel, or digital flexor sheath, extends distally to the proximal aspect of the distal phalanx [75]. The A2 and A4 pulleys are located over the middle portions of the proximal and middle phalanges, respectively [75]. These pulleys are the most essential for maintaining the mechanical advantage of the flexor tendons [75].

Intrinsic muscle anatomy includes the dorsal interossei, which are abductors lying to the radial side of the index and middle fingers and the ulnar side of the middle and ring fingers [68]. The volar interossei are adductors lying to the ulnar side of the index finger and the radial side of the ring and little fingers [68]. The superficial head of the dorsal interosseous muscles inserts onto the lateral tubercle of the base of the proximal phalanx [68]. The deep head forms a lateral tendon, or lateral band, at the metacarpophalangeal joint level [68]. Transverse fibers arch dorsally from each lateral band to join over the finger dorsum, flexing the proximal phalanx [68]. Oblique fibers from the lateral bands insert onto the lateral tubercles at the base of the middle phalanx to extend the proximal interphalangeal joint [68]. The volar interossei do not insert onto the proximal phalanx [68].

Dermal anatomy features thin dorsal skin with loose connections to deeper planes, allowing free gliding [77]. Finger flexion significantly lengthens the dorsal skin; in the middle finger, the distance between the wrist and the ungual fold increases by an average of 3 cm from extension to full flexion [77]. Dorsal and palmar skin areas are independent due to adhesions anchoring their common boundary to the underlying plane [77]. In the proximal first phalanx, skin fixation occurs in a straight line in the plane of the commissural crest [77]. Opposite the middle and distal phalanges, the adhesion band lies just posterior to the palmar collateral neurovascular bundle on the lateral side [77]. Digital neurovascular structures are surrounded by a diffuse network of thin transverse oblique fibers [78]. Fibers dorsal to the neurovascular bundle are collectively called Cleland ligament [78], while fibers palmar to the bundle are called Grayson ligament [78].

Joint Mechanics & Pathophysiology

The metacarpophalangeal joints serve as keystones of the hand’s longitudinal arches [71]. Volar plates prevent hyperextension at these joints, and their stability is essential for supporting the longitudinal and transverse metacarpal arches [71]. Kinematic chains link the wrist to the metacarpophalangeal joint, which affects the proximal interphalangeal joint, which in turn affects the distal interphalangeal joint [76]. Almost all hand movements occur around oblique and variable axes, resulting in combined movements [76]. Under load in the crimp grip position, the volar plate translates distally relative to the middle phalanx base [88]. The volar plate of the proximal interphalangeal joint undergoes three sequential phases of motion: sliding, elevating, and rolling in the recess [91].

Phalangeal fractures are the second most common upper-extremity fracture in the United States, with an incidence of 130/100,000 persons [47]. Intramedullary hand nail fixation requires the implant to penetrate articular cartilage during insertion [47]. Retrograde metacarpal screw fixation produces a focal cartilage defect on the metacarpal head [60]. This defect tracks across the entire proximal phalanx articular surface during metacarpophalangeal joint motion [60]. The arc during which the defect in the head of the proximal phalanx engages the base of the middle phalanx is almost entirely outside the functional range of motion of the proximal interphalangeal joint [96]. Phalanx fracture fixation with intramedullary hand nails has acceptable joint cartilage damage based on study data [15].

Classification

Chow et al. (1991): This system classifies extra-articular fractures of the proximal phalanx according to concurrent soft tissue injury [27]. Displaced unstable transverse fractures of the shaft of the proximal phalanx are common in industrial workers and are usually caused by heavy objects falling on the hand [27]. A rate of 25% of poor outcome has been observed in Chow's type I fractures despite favourable soft tissue conditions [27].

Other Considerations: Phalangeal fractures, older age, and associated soft-tissue injuries were significant risk factors for reduced range of finger motion in comminuted periarticular metacarpal and phalangeal fractures treated with a titanium plate [23]. Screw fixation is indicated for oblique and spiral fractures of the proximal phalanx [24]. Screw fixation is indicated for certain fractures with large single articular fragments involving the proximal interphalangeal joint [24]. Screw fixation is indicated for appropriate Bennett's fractures [24]. Intramedullary headless screw fixation (IHSF) could be considered as the current practice to treat extra-articular unstable fractures of metacarpals and phalanges, including complex cases [8]. Intramedullary compression screw (IMCS) fixation is a reliable technique for the surgical management of transverse and short oblique metacarpal, proximal and middle phalangeal fractures [28]. Unstable transverse fractures in the phalanx and metacarpal are amenable to single intramedullary cannulated headless compression screw (CHS) fixation [34]. The use of proximally locked nails may safely extend the indications to rotationally and longitudinally unstable fractures in metacarpal fractures [18]. Dorsal plating using a 1.5-mm modular hand plate is a viable option for rigid fixation of intra-articular middle phalangeal base fractures with volar instability [32]. A simple phalangeal external fixator using Kirschner wires and locking balls may be a useful tool for open and/or highly comminuted fractures and fracture-dislocations of the proximal and middle phalanges [62].

Clinical Presentation

Phalangeal fractures of the hand represent the second most common upper-extremity fracture in the United States, with a reported incidence of 130/100,000 persons [47]. Displaced unstable transverse fractures of the proximal phalanx shaft are frequently encountered in industrial workers, typically resulting from heavy objects falling on the hand [27]. These injuries are clinically significant, having been designated as "troublesome shaft fractures of the proximal phalanx" and the "no man's land" of hand fractures [27].

Classification: Extra-articular fractures of the proximal phalanx are classified according to concurrent soft tissue injury [27]. Even in the presence of favourable soft tissue conditions, a rate of 25% of poor outcome has been observed in Chow's type I transverse fractures of the proximal phalanx [27].

Risk Factors: In comminuted periarticular metacarpal and phalangeal fractures, phalangeal fractures, older age, and associated soft-tissue injuries were significant risk factors for reduced range of finger motion [23].

Investigations

Physical Examination: A careful physical examination is essential to direct care and future testing if indicated for the injured or dysfunctional hand and wrist [52]. Diagnostic tests such as imaging and serum laboratory studies are useful in the determination of pathology but can be expensive, time consuming, and often nonspecific [52].

Other Considerations: The skeleton of the hand and wrist consists of 27 bones, of which 19 are long bones [54]. The skeleton is divided into five rays, each ray making up a polyarticulated chain comprising the metacarpals and phalanges [54]. The base of each metacarpal articulates with the distal row of the carpus [54]. The wrist has three axes of movement, permitting the hand to be positioned in any spatial configuration and allowing it to be placed as needed for grasping [54]. The thumb metacarpal is the shortest, and the index metacarpal is by far the longest [54]. The proximal and middle phalanges of the long and ring fingers are longer than those of the index finger [54]. The epiphyseal plates are located at the proximal ends of the phalanges and the first metacarpal, whereas they are located at the distal ends of the other metacarpals [54].

Soft Tissue Anatomy: Distal interphalangeal joint extension is achieved through the conjoined lateral bands that are composed of tendinous slips from the extrinsic and intrinsic tendons [53]. The digital extensor tendons are stabilized over the mid-line of the metacarpophalangeal joint by their attachment to sagittal band fibers [53]. The extrinsic finger flexors are the flexor digitorum profundus and the flexor digitorum superficialis [53]. The flexor digitorum profundus inserts on the proximal volar aspect of the distal phalanx, flexing the distal interphalangeal joint as well as the proximal interphalangeal and metacarpophalangeal joints [53]. The flexor digitorum superficialis acts as a flexor of the proximal interphalangeal and metacarpophalangeal joints [53].

Treatment

Operative

Indications: Screw fixation is indicated for a small percentage of hand fractures, specifically oblique and spiral fractures of the proximal phalanx, certain fractures with large single articular fragments involving the proximal interphalangeal joint, and appropriate Bennett's fractures [24]. For athletes, the goals of internal fixation are stable anatomic fracture restoration and early functional recovery [6].

Surgical Approach / Technique: Fixation of unstable proximal and middle phalangeal fractures using a titanium plate and screws through a midlateral approach is associated with higher total active motion and fewer complications than K-wire fixation [29]. For middle phalangeal neck fractures, percutaneous pinning uses flexion of the interphalangeal joints during K-wire insertion to maintain fracture reduction and improve fixation for acute, unstable extra-articular fractures [9]. Intramedullary compression screw fixation is a reliable technique for the surgical management of transverse and short oblique metacarpal, proximal and middle phalangeal fractures [28].

Implant Selection: No differences in outcome were observed between dorsal and lateral plate fixation for finger proximal phalangeal fractures [1]. No considerable biomechanical advantage of using a conventional 1.5 mm dorsal non-locking plate was identified over a novel 1.3 mm lateral locking plate in the treatment of proximal phalanx fractures [58]. An updated systematic review finds good functional outcomes and a low complication rate following the use of intramedullary screw fixation for proximal phalangeal fractures [10]. Postoperative finger stiffness occurred in 43% of fractures treated with titanium plates and/or screws [36].

Other Considerations: Closer distance between the plate edge and joint line is associated with a more limited range of finger motion in patients treated with a locking plate system [13]. Percutaneous pinning of proximal phalangeal base fractures resulted in permanent reduction in range of motion at the metacarpophalangeal and proximal interphalangeal joints [25]. The authors caution against prescribing any single method for fixing a particular type of fracture, recommending an individualised management strategy that considers fracture configuration, surgeon and patient preferences, and likely patient compliance [92].

Rehabilitation and Outcomes: Patients who commence active finger exercise early following proximal phalanx fracture surgical fixation may achieve greater total active range of motion at 6 weeks post-operatively than if active exercise is delayed [33]. By Week 6, there were no significant between-group differences in improvement for active proximal interphalangeal joint extension, total active finger range of motion, strength, pain, difficulty with specific hand activity, or difficulty with usual hand activity between two types of exercise after proximal phalangeal fracture fixation [35].

Complications

Stiffness / Arthrofibrosis: Postoperative finger stiffness occurred in 43% of fractures treated with titanium plates and/or screws for unstable proximal phalangeal fractures [36]. In unstable metacarpal and phalangeal fractures treated with a locking plate system, a closer distance between the plate edge and the joint line is associated with a more limited range of finger motion [13]. Both techniques for percutaneous pinning of proximal phalangeal base fractures resulted in a permanent reduction in range of motion at the MCP and PIP joints [25]. Patients who commence active finger exercise early following proximal phalanx fracture surgical fixation may achieve greater total active ROM at 6 weeks post-operatively than if active exercise is delayed [33].

Infection: There was no significant difference in postoperative infection rates between buried and exposed K-wires after metacarpal and phalangeal fracture osteosynthesis [82]. Bridge plating for first proximal phalanx intra-articular base fractures avoids the risk of pin-track infections associated with external fixation [64]. The removal of intramedullary nails used for metacarpal or phalanx fracture fixation in the case of infection is theorized to be more difficult than the removal of plates and wires [57].

Hardware-Related Complications: Unplanned reoperation was more prevalent after plate fixation compared to other methods in a cohort of 143 proximal phalanx fractures [84]. Screw fixation of distal phalanx fractures required removal in half of cases [12] and was associated with a 52% incidence of symptomatic hardware necessitating operative removal [40].

Other Considerations: Plate and screw osteosynthesis involves extensive surgical exposure and carries the risk of scarring, adhesions, delayed union, and a high risk of reintervention [43]. Percutaneous K-wire fixation has limitations such as inadequate compression and reduced rigidity, often requiring additional immobilization [43]. Intramedullary hand nails for phalanx fracture fixation have acceptable joint cartilage damage based on study data [15]. Suture anchors should be used with caution in the little finger, and patients should be forewarned about potential complications regarding flexor digitorum profundus fixation in the distal phalanx [46]. Traumatic avulsion of the finger nail in skeletally immature patients should be recognized as an open fracture to prevent complications such as infection and premature epiphyseal closure [105].

Recovery

Functional Outcomes and Benchmarks: Closed reduction and percutaneous Kirschner-wire fixation via a joint-sparing approach yields good functional results with no or minimal complications in proximal phalangeal neck fractures [5]. Dual antegrade intramedullary headless screw fixation of proximal phalanx fractures results in excellent postoperative motion, near-normal grip strength, positive self-reported patient outcomes, and no complications with follow-up of at least 1 year [50]. Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both closed-reduction percutaneous pinning and open-reduction internal fixation with lag screws [38]. A multicentre study with long-term follow-up suggests intramedullary headless screw fixation could be considered as the current practice to treat extra-articular unstable fractures of metacarpals and phalanges, including complex cases [8]. Patients receiving percutaneous pin or intramedullary nail fixation have equivocal union and complication rates [55].

Range of Motion and Rehabilitation: Closer distance between the plate edge and joint line is associated with a more limited range of finger motion, and clinical outcomes approached an acceptable level at final follow-up [13]. Both techniques for percutaneous pinning of proximal phalangeal base fractures resulted in permanent reduction in range of motion at the metacarpophalangeal and proximal interphalangeal joints [25]. All six fingers obtained satisfactory union of the fractures, and no patient complained of pain at the final follow-up after intramedullary fixation through a volar extra-tendon sheath approach [7].

Complications and Adverse Events: These very favourable results suggest that miniature plates and screws are a possible choice in the treatment of low-severity metacarpal and phalangeal fractures [4]. The low-profile titanium plate system was highly effective in maintaining anatomic reduction despite the technical demands of plating for comminuted metacarpal and phalangeal fractures [11].

Key Evidence

  • [L3] No differences in the outcome of finger proximal phalangeal fractures treated by dorsal and lateral plate fixation were observed. [1] (10.1007/s00402-017-2650-x)
  • [L3] Excellent outcomes were achieved, providing a benchmark for recovery after ORIF of proximal phalangeal fractures. [2] (10.1177/1753193416670591)
  • [L4] Intramedullary screw fixation of proximal phalangeal fractures is safe, providing stable fixation to allow early motion. [3] (10.1177/1558944720928503)
  • [Paper] These very favourable results suggest that miniature plates and screws are a possible choice in the treatment of low-severity metacarpal and phalangeal fractures. [4] (10.1007/s00402-004-0745-7)
  • [L2] Closed reduction and percutaneous Kirschner-wire fixation by a joint sparing approach will yield good functional results with no or minimal complications in proximal phalangeal neck fractures. [5] (10.1177/1753193419894143)
  • [L5] Stable anatomic fracture restoration and early functional recovery are the goals of internal fixation of hand fractures. [6] (10.1016/j.hcl.2009.05.005)
  • [L4] All six fingers obtained satisfactory union of the fractures, and no patient complained of pain at the final follow-up. [7] (10.1142/s0218810411005230)
  • [L4] On the basis of the results of this multicentre study with a long-term follow-up, we believe that IHSF could be considered as the current practice to treat extra-articular unstable fractures of metacarpals and phalanges, not only in case of single fractures but also in complex cases. [8] (10.1177/1753193420980324)
  • [L4] The presented technique uses flexion of the interphalangeal joints during K-wire insertion to maintain fracture reduction and improve fixation for acute, unstable extra-articular middle phalangeal neck fractures. [9] (10.1016/j.jhsa.2012.06.011)
  • [L4] This updated systematic review finds good functional outcomes and a low complication rate following the use of IMS fixation for proximal phalangeal fractures. [10] (10.1177/15589447251329597)
  • [L4] Despite the technical demands of plating for comminuted metacarpal and phalangeal fractures, the low-profile titanium plate system was highly effective in maintaining anatomic reduction. [11] (10.1016/j.jhsa.2008.01.040)
  • [L3] Screw fixation of distal phalanx fractures resulted in greater distal interphalangeal joint motion compared with K-wire fixation but required removal in half of cases. [12] (10.1016/j.jhsa.2015.06.125)
  • [L2] Closer distance between the plate edge and joint line is associated with a more limited range of finger motion, and clinical outcomes approached an acceptable level at final follow-up. [13] (10.1177/1753193419899332)
  • [L5] Both unicortical and bicortical locking screws provide sufficient stability to facilitate early motion without risk of clinically relevant displacement during plate fixation of midshaft proximal phalangeal fractures. [14] (10.1016/j.jhsa.2025.03.009)
  • [L5] Phalanx fracture fixation with intramedullary hand nails may be beneficial as it has acceptable joint cartilage damage based on study data. [15] (10.1016/j.jhsg.2025.100928)
  • [L5] The authors describe a minimally invasive technique for screw fixation of phalangeal finger fractures that combines the advantages of percutaneous K-wire stabilisation with internal rigid fixation. [16] (10.1016/j.injury.2020.04.020)
  • [L4] Intramedullary screw fixation is a viable option in the treatment of extra-articular middle phalangeal fractures. [17] (10.1016/j.jhsa.2023.12.011)
  • [L4] The use of proximally locked nails may safely extend the indications to rotationally and longitudinally unstable fractures and minimizes the need for postoperative splinting in metacarpal fractures. [18] (10.1016/j.hcl.2006.02.017)
  • [L4] Internal fixation of metacarpal and phalangeal fractures is a reliable method for fractures with significant displacement, rotation, angulation and/or instability. [19] (10.1016/0020-1383(93)90283-c)
  • [L5] Closed reduction and percutaneous pinning using any of the presented techniques is an adequate method of treatment for unstable proximal phalanx fractures. [21] (10.1177/15589447211017224)
  • [L1] This study demonstrates evidence favoring the lateral plating approach when fixing proximal phalanx fractures. [22] (10.1177/15589447251378679)
  • [L3] Phalangeal fractures, older age, and associated soft-tissue injuries were significant risk factors for reduced range of finger motion. [23] (10.1016/j.injury.2012.02.011)
  • [L4] Screw fixation is indicated for a small percentage of hand fractures, specifically oblique and spiral fractures of the proximal phalanx, certain fractures with large single articular fragments involving the proximal interphalangeal joint, and appropriate Bennett's fractures. [24] (10.2106/00004623-197658040-00010)
  • [L3] Both techniques resulted in permanent reduction in range of motion at the MCP and PIP joints. [25] (10.1016/s0363-5023(12)60053-7)
  • [L4] This study concurs with the prior literature that intramedullary screw fixation is a safe and effective method of stabilizing extra-articular proximal phalangeal fractures in the short to medium term. [26] (10.1177/15589447241235339)
  • [L4] [27] (10.1177/1753193411405943)
  • [L4] IMCS fixation is a reliable technique for the surgical management of transverse and short oblique metacarpal, proximal and middle phalangeal fractures. [28] (10.1302/2058-5241.5.190068)
  • [L2] Fixation of unstable proximal and middle phalangeal fractures using a titanium plate and screws through a midlateral approach is a reliable and safe method for most fracture types and is associated with higher TAM and fewer complications. [29] (10.1016/j.jhsa.2019.01.015)
  • [L4] Rigid internal fixation of basilar metaphyseal proximal phalangeal fractures by cancellous bone grafting alone is feasible and produces rewarding results. [30] (10.1054/jhsb.2001.0641)
  • [L4] Dorsal plating using a 1.5-mm modular hand plate is a viable option for rigid fixation of intra-articular middle phalangeal base fractures with volar instability. [32] (10.1177/1558944718777868)
  • [L4] Patients who commence active finger exercise early following proximal phalanx fracture surgical fixation may achieve greater total active ROM at 6 weeks post-operatively than if active exercise is delayed. [33] (10.1177/1758998316679386)
  • [L4] Unstable transverse fractures in the phalanx and metacarpal are amenable to single intramedullary CHS fixation. [34] (10.1016/j.jhsa.2014.11.023)
  • [L1] By Week 6, there were no significant between-group differences in improvement for active proximal interphalangeal joint extension, total active finger range of motion, strength, pain, difficulty with specific hand activity, or difficulty with usual hand activity. [35] (10.1016/j.jphys.2015.11.006)
  • [L2] Postoperative finger stiffness occurred in 43% of fractures. [36] (10.1016/j.jhsa.2014.06.107)
  • [L3] Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both CRPP and ORIF-screws. [38] (10.1177/15589447211003185)
  • [Commentary] [40] (10.1016/j.jhsa.2015.08.021)
  • [L5] [43] (10.1177/17531934251316495)
  • [L5] Suture anchors should be used with caution in the little finger and patients forewarned about potential complications. [46] (10.1177/1753193411419595)
  • [L5] [47] (10.1016/j.jhsg.2026.101064)
  • [L4] Dual antegrade IMHS fixation of proximal phalanx fractures resulted in excellent postoperative motion, near-normal grip strength, positive self-reported patient outcomes, and no complications with follow-up of at least 1 year. [50] (10.1177/1558944717750919)
  • [L3] This study demonstrates that patients receiving percutaneous pin or IM nail fixation have equivocal union and complication rates. [55] (10.1177/15589447241232009)
  • [L3] [57] (10.1177/17531934241277949)
  • [L5] No considerable biomechanical advantage of using a conventional 1.5 mm dorsal non-locking plate was identified over the novel 1.3 mm lateral locking plate in the treatment of proximal phalanx fractures. [58] (10.1016/j.clinbiomech.2015.03.019)
  • [L5] Retrograde metacarpal screw fixation produces a focal cartilage defect on the metacarpal head that tracks across the entire proximal phalanx articular surface during MCP joint motion. [60] (10.1016/j.jhsg.2025.100847)
  • [L4] [62] (10.1016/j.jhsa.2016.04.017)
  • [L4] Bridge plating may be an alternative to external fixation for certain thumb fractures, with the potential to maintain alignment and articular congruity while permitting earlier return to activities of daily living and avoiding the risk of pin-track infections. [64] (10.1016/j.jhsg.2022.09.003)
  • [L3] There was no significant difference in postoperative infection rates between buried and exposed K-wires. [82] (10.1016/j.injury.2018.02.027)
  • [L4] Overall patient-reported outcome measure scores were similar across fixation methods, and unplanned reoperation was more prevalent after plate fixation. [84] (10.1016/j.jhsa.2019.08.010)
  • [L4] This article describes a volar plate translation in a distal direction relative to the middle phalanx base in the crimp grip position when the flexor tendons are under load. [88] (10.1016/j.jhsa.2012.02.016)
  • [L4] The authors propose three sequential phases of volar plate motion: sliding, elevating, and rolling in the recess. [91] (10.1016/j.jhsa.2010.10.034)
  • [L5] The authors caution against prescribing any single method for fixing a particular type of fracture, recommending an individualised management strategy that considers fracture configuration, surgeon and patient preferences, and likely patient compliance. [92] (10.1177/1753193411433386)
  • [L5] A longitudinal groove runs the length of the phalangeal shaft, and dorsally placed bicortical screws could protrude into this groove unnoticed on intraoperative imaging, potentially causing impingement on the flexor tendon. [95] (10.1016/j.jhsa.2016.12.009)
  • [L5] The arc during which the defect in the head of P1 engages the base of the P2 is almost entirely outside the functional ROM of the PIP joint. [96] (10.1016/j.jhsa.2023.11.014)
  • [L4] Traumatic avulsion of the finger nail in skeletally immature patients should be recognized as an open fracture to prevent complications such as infection and premature epiphyseal closure. [105] (10.2106/00004623-197860050-00027)

See Also

References

[1] Dorsal versus lateral plate fixation of finger proximal phalangeal fractures: a retrospective study. Archives of Orthopaedic and Trauma Surgery. 2017. DOI: 10.1007/s00402-017-2650-x

[2] Pattern of recovery after open reduction and internal fixation of proximal phalangeal fractures in the finger: a prospective longitudinal study. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416670591

[3] Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review. HAND. 2020. DOI: 10.1177/1558944720928503

[4] Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Archives of Orthopaedic and Trauma Surgery. 2004. DOI: 10.1007/s00402-004-0745-7

[5] Joint sparing Kirschner-wire fixation for displaced proximal phalangeal neck fractures: randomized prospective comparative study. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419894143

[6] Operative Fixation of Metacarpal and Phalangeal Fractures in Athletes. Hand Clinics. 2009. DOI: 10.1016/j.hcl.2009.05.005

[7] INTRAMEDULLARY FIXATION OF PROXIMAL PHALANGEAL FRACTURES THROUGH A VOLAR EXTRA-TENDON SHEATH APPROACH. Hand Surgery. 2011. DOI: 10.1142/s0218810411005230

[8] Outcomes of 173 metacarpal and phalangeal fractures treated by intramedullary headless screw fixation with a 4-year follow-up. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193420980324

[9] Percutaneous Pinning of Middle Phalangeal Neck Fractures: Surgical Technique. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.06.011

[10] Intramedullary Compression Screw Fixation of Proximal Phalanx Fractures: An Updated Systematic Review. HAND. 2025. DOI: 10.1177/15589447251329597

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