Anatomical distribution and treatment for fractures and dislocations of the proximal and middle phalanges: a multicentre snapshot study of 461 patients

Abstract

Purpose: To evaluate the anatomical distribution of fractures and dislocations of the proximal and middle phalanges, the current treatment modalities, and potential variations in treatment approaches. Methods: This multi-centre cross-sectional study included patients presenting with single fractures of the proximal or middle phalanges and dislocations (excluding the thumb) over a three-month period in 2020. Data collection included demographic details, injury location and fracture pattern, and treatment modalities. Treatment categories included non-operative management (e.g., functional treatment allowing digit mobilisation, immobilisation, and immobilisation duration), surgical interventions, and post-operative care (functional treatment or immobilisation and immobilization duration). Results: A total of 461 patients were included, with 395 (86%) managed non-operatively and 66 (14%) undergoing surgical intervention. The most frequently encountered injuries were proximal interphalangeal joint (PIPJ) avulsion fractures (137/461, 30%), followed by proximal phalanx shaft fractures (132/461, 29%), and dorsal PIPJ dislocations (57/461, 12%). Among patients with PIPJ palmar plate avulsion fractures managed non-operatively, 72% (88/123) were treated with functional treatment in the emergency department (ED), increasing to 94% after the initial follow-up. For proximal phalanx shaft fractures this was 28% (26/93), increasing to 53% after follow-up, and for PIPJ dislocations this was 71%, increasing to 80%. The rates of functional treatment for PIPJ avulsion fractures and dislocations showed significant variation across hospitals (p < 0.001). Operative treatment of proximal and middle shaft fractures primarily involved closed reduction and K-wire fixation, performed in 69% (25/36) and 82% (9/11) of the cases, respectively. Conclusion: This study provides valuable insights into the anatomical distribution of various types of injuries of the proximal and middle phalanges, including intra-articular and avulsion fractures and dislocations. Additionally, it highlights practice variations in non-operative treatment approaches and immobilisation duration, influenced by hospital setting. These findings could inform future research aimed at optimizing treatment strategies for these prevalent injuries.