Troublesome shaft fractures of the proximal phalanx. Early treatment to avoid late problems at the metacarpophalangeal and proximal phalangeal joints.

Although any fracture of the proximal phalanx can potentially disrupt finger MCP and/or PIP motion, appropriate consideration based on sound principles of biomechanics and biology of healing will delineate the options available. Applying the risk/benefit associated with any particular mode of treatment is more challenging. Perhaps the most difficult thing is to anticipate and recognize failure of a treatment mode sufficiently early and then to act concisely to rectify the situation. The physician and patient must recognize what goal is realistic for each patient's injury. This encompasses the patient factors as outlined, as well as a clear awareness in the surgeon's mind of his or her technical limitations and expertise. Final function and range of motion of the MCP and PIP joints will depend not only on bony union in good position, but on restoration of the gliding function of the flexor and extensor tendons that are contiguous to the fracture site.