The phalanges make up the bone architecture of the fingers and thumb. In each finger, there are 3 phalanges and in the thumb, there are 2. As with metacarpal fractures, phalangeal fractures are assessed both on clinical examination as well as x-ray evaluation. If there is good function within the hand and no rotational deformity on making a fist, then treatment can consist of conservative management and splinting. If the fracture is displaced and or giving significant functional problems, then open reduction and fixation would be warranted. Fixation is done under regional block anesthesia and can include either pins and/or screws. Pins typically stay in the body for approximately 4 to 5 weeks and then therapy is initiated. With screws, which afford better stabilization of the fracture, therapy can be initiated within several days subsequent to the surgical procedure.
In either event, the fracture has to be protected with a removable and/or static orthosis to protect the healing of the bone. Typical problems that can arise after fracture of the phalanges and after surgery include adhesions about the respective tendons and stiffness within the joints. This is why therapy is critical as soon as possible in postoperative care of these patients. The possibility for a second surgery is also seen if the patient does not respond to therapeutic efforts and develops marked stiffness about the joints and/or tendons. This type of surgery removes the scar tissue around the joint, i.e., capsulectomy, or about the tendons, i.e., tenolysis.