Research Article| Volume 1, ISSUE 1, P14-24, February 2001

Unicondylar and bicondylar proximal phalangeal fractures


      Anatomic position, stability, and early motion are the key principles for achieving good results with all types of intra-articular condylar fractures of the proximal phalanx. When stabilization is necessary, soft tissue trauma should be minimized to lessen the risk of scar formation and consequent stiffness at the proximal interphalangeal joint. Oblique unicondylar fractures treated with 2-point (or more) Kirschner wire or 1 (or more) mini-screw fixation(s) have the best results. This is also true of bicondylar fractures, although mini-condylar plate fixation may achieve equally good results in bicondylar fractures with large condylar fragments. Screw fixation is recommended for triplane fractures. Although loss of reduction, delayed treatment, nonunion, deformity, or arthritis may complicate these injuries, stiffness is the most frequent and serious complication. Infection is rare. Copyright © 2001 by the American Society for Surgery of the Hand
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect



        • Swanson AB
        Fractures involving digits of the hand.
        Orthop Clin North Am. 1970; 1: 261-274
        • London PS
        Sprains and fractures involving the interphalangeal joints.
        Hand. 1971; 3: 155-158
        • Weiss APC
        • Hastings II, H
        Distal unicondylar fractures of the proximal phalanx.
        J Hand Surg [Am]. 1993; 18A: 594-599
        • Chin K
        • Jupiter JB
        Treatment of triplane fractures of the head of the proximal phalanx.
        J Hand Surg [Am]. 1999; 24A: 1263-1268
        • Baratz ME
        • Divelbiss B
        Fixation of phalangeal fractures.
        Hand Clin. 1997; 13: 541-555
        • Barton NJ
        Fractures of the hand.
        J Bone Joint Surg Br. 1984; 66B: 159-167
        • Barton NJ
        Intraarticular fracture and fracture dislocations.
        in: The interphalangeal joints. Churchill Livingstone, London1987: 77-93
        • Steel WM
        Articular fractures.
        in: Fractures of the hand and wrist. Churchill Livingstone, London1988: 55-73
        • McCue FC
        • Honner R
        • Johnson Jr, MC
        • Gieck JH
        Athletic injuries of the proximal interphalangeal joint requiring surgical treatment.
        J Bone Joint Surg Am. 1970; 52A: 937-955
        • Crawford GP
        Screw fixation for certain fractures of the phalanges and metacarpals.
        J Bone Joint Surg Am. 1976; 58A: 487-492
        • Hastings II, H
        • Carroll C IV
        Treatment of closed articular fractures of the metacarpal, phalangeal and proximal interphalangeal joints.
        Hand Clin. 1988; 4: 503-527
        • Freeland AE
        • Benoist LA
        Open reduction and internal fixation method for fractures at the proximal interphalangeal joint.
        Hand Clin. 1994; 10: 239-250
        • Ramos LE
        • Becker GA
        • Grossman JA
        A treatment approach for isolated unicondylar fractures of the proximal phalanx.
        Ann Chir Main. 1997; 16: 305-309
        • Strickland JW
        • Steichen JB
        • Kleinman WB
        • Hastings II, HH
        • Flynn N
        Phalangeal fractures-factors influencing performance.
        Orthop Rev. 1982; 1: 39-50
        • Yousif NJ
        • Cunningham MW
        • Sanger JR
        • Gingrass RP
        • Matloub HS
        The vascular supply to the proximal interphalangeal joint.
        J Hand Surg [Am]. 1985; 10A: 852-861
        • Rayhack JM
        • Bottke CA
        Intraosseous compression wiring of displaced articular condylar fractures.
        J Hand Surg [Am]. 1990; 15A: 370-373
        • Buchler U
        • Fisher T
        Use of a minicondylar plate for metacarpal and phalangeal periarticular injuries.
        Clin Orthop. 1987; 214: 53-57
        • Ouellette EA
        • Freeland AE
        Use of the minicondylar plate in metacarpal and phalangeal fractures.
        Clin Orthop. 1996; 237: 38-46
        • O'Rourke SK
        • Gaur S
        • Barton NJ
        Long-term outcome of articular fractures of the phalanges: an eleven year follow-up.
        J Hand Surg [Br]. 1989; 14B: 183-193
        • Duran RS
        • Houser RG
        Controlled passive motion following flexor tendon repair in zones two and three.
        in: AAOS symposium on flexor tendon surgery in the hand. CV Mosby, St. Louis1975: 105-114