Purpose
To investigate the volar anatomy of the middle phalanges of the hand; in particular,
to define the presence and depth of a volar midline longitudinal groove.
Methods
Measurements were performed at 5 equidistant points along the shafts of 60 skeletonized
middle phalanges from 15 cadaveric hands. The thickness at the midline of each phalanx
was subtracted from the maximal dorsovolar thickness to indicate the presence or absence
of a groove at each point. The phalanges were also evaluated by computed tomography
to confirm the presence of a volar groove and to rule out morphological abnormalities.
Results
A volar groove was confirmed in all 60 phalanges. The groove had an average depth
of 0.4 mm and was found to be deepest at the mid-phalangeal shaft. The groove reached
a depth of greater than 1 mm in 23% of the phalanges. The middle phalanges of the
middle and ring digits consistently revealed deeper grooves than those found in the
index and little fingers. Computed tomography confirmed the presence of a volar groove
and showed no morphological abnormalities.
Conclusions
A midline volar longitudinal groove is present in the middle phalanges, is most pronounced
in the mid-phalangeal shaft, and is the deepest in the middle and ring fingers.
Clinical relevance
Surgeons should be cognizant of the volar longitudinal groove when inserting screws
from dorsal to volar during the fixation of middle phalangeal fractures. Lateral intraoperative
fluoroscopy may not reveal excessive screw penetration because of the presence of
ridges on either side of the groove. Particular care should be taken at the mid-phalangeal
level of the middle phalanges of the middle and ring fingers.
Key words
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References
- The epidemiology of upper extremity fractures in the United States, 2009.J Orthop Trauma. 2015; 29: e242-e244
- Intramedullary compression screw fixation of proximal phalangeal fractures: a systematic literature review.Hand (N Y). 2022; 17: 595-601
- The frequency and epidemiology of hand and forearm fractures in the United States.J Hand Surg Am. 2001; 26: 908-915
- Operative treatment of metacarpal and phalangeal shaft fractures.J Am Acad Orthop Surg. 2000; 8: 111-121
- Temporal trends in the management of metacarpal and phalangeal fractures in the 21st century: an analysis of Australian population-based data.ANZ J Surg. 2022; 92: 2655-2660
- Range of motion following extensor tendon splitting vs. tendon sparing approaches for plate osteosynthesis of proximal phalangeal fractures - a systematic review and meta-analysis.J Hand Surg Asian Pac Vol. 2020; 25 (Published correction appears in J Hand Surg Asian Pac Vol. 2021;26(2):308): 462-468
- Skeletal anatomy of the hand.Hand Clin. 2013 Nov; 29: 459-471
- Internal morphology of human phalanges.J Hand Surg Am. 1984; 9: 490-495
- Flexor pulley system: anatomy, injury, and management.J Hand Surg Am. 2014; 39 (quiz 2533): 2525-2532
- Volar anatomy of the proximal phalanx: implications for screw length selection for fixation of shaft fractures.J Hand Surg Am. 2017; 42: e149-e157
- Bony palmar ridges of the phalanges of the human fingers.Surg Radiol Anat. 2014; 36: 587-593
- Complications of plate fixation in the hand skeleton.Clin Orthop Relat Res. 1987; 214: 59-65
Article Info
Publication History
Published online: November 10, 2022
Accepted:
October 3,
2022
Received:
June 27,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
