[Distal phalangeal fractures of the finger. Results of conservative and surgical treatment].

Background: In this study 56 dorsal phalangeal fractures of the distal segment were classified regarding morphological criteria.
Material and Methods: Clinical and radiological results after 4 months were analyzed. Fractures including subluxation of the distal interphalangeal joint occurred rarely (n=3) and were treated by surgery. Fractures without subluxation had either a triangle-shaped fragment (n=40) or a fragment similar to a hunter's hat (n=9). Furthermore, there were two fractures with a tiny bony avulsion and two fractures with more radial or ulnar-oriented fragments. The triangle and hunter's hat type fractures were treated either by splinting (n=20) or by open reduction and stabilization with screws and wires (n=29).
Results: Clinical outcome was similar in both groups. In 12 out of the 20 fractures treated by splinting a stepping of the joint surface had to be tolerated. Initially only 8 out of 20 fractures showed a stepping of the joint surface. The fractures treated by surgery showed a better radiological outcome.
Conclusions: Initially 27 fractures showed a stepping in the joint line but after surgical treatment only 9 fractures still presented a stepping. The remaining four fractures were successfully treated by splinting.