Fractures at the junction of diaphysis and metaphysis of the proximal phalanges in adults.

We describe the treatment of 101 patients with 113 fractures of the proximal phalanx at the junction of the diaphysis with the proximal metaphysis. Fractures were stabilized using a single extra-articular percutaneous Kirschner wire passed lateral to the metacarpal head into the base of the phalanx base and across the fracture to engage the lateral cortex. Patients were treated semi-electively on a day surgery unit. The metacarpophalangeal joint was splinted in flexion with mobilization of the proximal inter-phalangeal joints, until the wire was removed at 24 days and the hand then freely mobilized. The mean total active movement was 230° and no patients experienced problems with significant pain. There were two pin site infections. There were no cases of angular or rotational malunion. These injuries can be successfully and safely treated using this simple technique, negating the need for close monitoring for angular displacement of the fracture, which is frequently seen with non-surgical management.

LEVEL OF EVIDENCE: IV.