Schatzker III Fracture Equivalent Of Base Of Middle Phalanx
Abstract
Fractures of base of middle phalanx are usually intra articular. Such fractures are a challenge to manage either surgically or conservatively. We report a 45 year old male with an unusual intra articular fracture of the base of middle phalanx of his middle finger.
Case Report
45 year old right hand dominant male presented with painful right middle finger following a valgus injury to his proximal interphalangeal joint at work 4 weeks ago. Examination revealed a swollen and tender proximal interphalangeal joint with decreased range of movements.
Radiographs showing depressed fracture of the lateral condyle
Radiographs showed a depressed intra articular fracture of the lateral condyle of the base of middle phalanx. As the injury was more than 4 weeks old he was managed conservatively. He made a reasonable recovery with functional range of pain free movements of the proximal inter phalangeal joint.
Discussion
Traditionally, fractures of the base of the middle phalanx have been classified into palmar or dorsal fracture dislocations.
Seno et al (1997) classified fractures of base of middle phalanx into 5 types
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single palmar fragment
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2single dorsal fragment
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2 main fragments
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extra articular and epiphyseal injuries
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all others(sagittal splits)
In our case we had an isolated depressed fracture of the lateral condyle which has not been reported in literature. This fracture was managed conservatively with reasonable results. Such fracture can be missed easily and hence should be considered in a patient with valgus or varus stress injury to proximal and distal interpahalangeal joints of the fingers. This type
of fracture corresponds to tibial plateau fracture (Schatzker III) which is a consequence of impaction of the condyle of the head of the proximal phalanx into the base of the middle phalanx..
Conclusion
Isolated depressed fracture of base of middle phalanx should be considered in the varus or valgus injuries of proximal interphalangeal joint.
Correspondence to
PK Inaparthy (MRCS) 2, Magnolia House Springwood road Barming, Maidstone UK ME16 9PB i_praveen@yahoo.com Phone: 00441622224318
R Botchu (MRCS) Orthopedic department Maidstone Hospital Maidstone UK – ME16 9QQ
J Gaskin (MRCS) Orthopedic department Maidstone Hospital Maidstone UK – ME16 9QQ
M Katchburian (FRCS – Orth) Consultant Orthopaedic surgeon Orthopedic department Maidstone Hospital Maidstone UK – ME16 9QQ
