Concomitantly intra-articular fracture of proximal condylar second and third proximal phalanges: A rare case report

CASE

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InternationalJournalofSurgeryCaseReports24(2016)94–96

ContentslistsavailableatScienceDirect

International

Journal

of

Surgery

Case

Reports

jo u r n al ho me p a g e :w w w . c a s e r e p o r t s . c o m

Concomitantly

intra-articular

fracture

of

proximal

condylar

second

and

third

proximal

phalanges:

A

rare

case

report

Baran

Kömür

_,

_Olcay

_Güler

_,

_Serhat

_Mutlu

_,

_Barıs¸

_Yılmaz

_,

_Bülent

_Yücel

_,

Tahir

Mutlu

Duymus¸

a_{KanuniSultanSüleymanTrainingandResearchHospital,Istanbul,Turkey} b_{MedipolMedicalFaculty,Istanbul,Turkey}

c_{FatihSultanMehmetTrainingandResearchHospital,Istanbul,Turkey}

a

r

t

i

c

l

e

i

n

f

o

Articlehistory: Received2March2016

Receivedinrevisedform6May2016 Accepted7May2016

Availableonline12May2016

Keywords:

Proximalphalangefracture Condylarfractureofphalanx Conservativetreatment

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INTRODUCTION:Ararecaseofproximalphalangefractureshasbeenpresentedinthisstudy.

PRESENTATIONOFCASE:A29-year-oldmalepatientfromTurkeywasadmittedtotheorthopedicsand

traumatologyclinicwithacomplaintoflefthandpain,whichhadpersistedfor10days.Hedescribeda

rotationaltraumathathadoccurredrightafterhittinghishandonthewheelofacarasaresultofanin-car

trafficaccident10daysago.Radiologicalwork-upswererequested.Intheanteroposterior(AP)graphof

thecaseinwhichthefracturelinecouldnotbeobservedintheobliquegraph,unicondylarfracturesin

theproximalsectionofthesecondandthirdproximalphalangeshavebeenobserved.Surgicaltreatment

wasnotplannedbecause10dayshadpassedsincethetrauma.Inthecontrolgraphstakenafter3weeks,

healingatthefracturesitewasobserved,andhewasreferredtophysiotherapyaftertheremovalofthe

splint.Agoodresultwasobservedafterphysiotherapy.

DISCUSSION:Becauseoftheextensionoftendonsisimportantoverthebone,thegoalofthetreatment

isnotonlytohealthefracture,butalsotopreservetheslidingmechanismofthesetendons.Regarding

tolackofsofttissuetrauma,favoredjointmovementsafterthehealingofthefracturecanbeachieved

moreeasilywithconservativetreatment;however,thefracturemustbecloselyfollowedup.

CONCLUSION:Condylarfracturesofproximalphalangesthosenondisplacedcanbeconservativelytreated

withclosedmethods.

©2016TheAuthor(s).PublishedbyElsevierLtdonbehalfofIJSPublishingGroupLtd.Thisisanopen

accessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction

Phalangealfracturesarethemostcommonfracturesofthehand. Whentheyarenottreatedappropriately,theycancauselimitation of movementability. In total, 13% ofhand fractures are proxi-malphalangealfractures.They arecommonly seen inmales in theagegroup20–29.Althoughtheexactmechanismleadingto theinjuryis unknown,it canbecausedby theavulsion of col-lateralligamentortiltandshearofthejointasaresultofaxial overload.Inmajorityofsuchfractures,fixationisneededbecause ofinstability.Improperhealingoffracturesofthistypecanlead todeformitiesandarthroses. Treatmentofproximalphalangeal fracturescansometimesbetroublesome.Asaresultofsofttissue traumathatoccursduringthesurgicaltreatmentcanleadto

lim-∗ Correspondingauthorat:KanuniSultanSüleymanTrainingandResearch Hos-pital,TurgutOzalSt.No.1,Istanbul,Turkey.

E-mailaddresses:barankomur@gmail.com(B.Kömür),

olcayguler77@gmail.com(O.Güler),serhatmutlu@hotmail.com(S.Mutlu),

drbyilmaz@yahoo.com(B.Yılmaz),dr2000tr@yahoo.com(B.Yücel),

dr.tahirmutlu@gmail.com(T.M.Duymus¸).

itationofmovementabilityofjointduetoadhesions[1].Onthe otherhand,reductioncanbeinsufficientwithconservative treat-ment.Inhandfractures,theaimistopreventjointstiffness,whichis achievedwithjointmovementfollowingthehealingofthefracture withacceptablealignment.Duringthesurgicaltreatmentof condy-larfracturesofphalanges,methodssuchask-wire,lagscrews,and externalfixationcanbeapplied[2,3].Amongthesemethods,no significantdifferencehasbeendetectedintermsofstabilization [4].

Inthisreport,wepresentararecasethatwasnotdefinedbefore tothebestofourknowledge.

2. Presentationofcase

A29-year-oldmalepatientfromTurkeywasadmittedtothe orthopedicsandtraumatologyclinicwithcomplaintsoflefthand pain,whichhadpersistedfor10days.Inhishistory,hedescribed arotationaltraumathathadoccurredrightafterhittinghishand onthewheelofacarasaresultofanin-cartrafficaccident10days ago.Inphysicalexamination,pain,tenderness,andlimitationof movement ability in the region where theproximal phalanges

http://dx.doi.org/10.1016/j.ijscr.2016.05.013

2210-2612/©2016TheAuthor(s).PublishedbyElsevierLtdonbehalfofIJSPublishingGroupLtd.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense(http://

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B.Kömüretal./InternationalJournalofSurgeryCaseReports24(2016)94–96 95

Fig.1. aandbAPandobliqueviewofthefracture.

Fig.2.aandbAPandobliqueviewofthefractureafterconservativetreatment.

Fig.3.aandbViewoftheinjuredhandwhileformingfist.

ofthesecondandthirdfingersarticulatewithmetacarpalbones havebeenreported.Flexor,extensortendonandothersofttissue examinationwasnormal.Radiologicalwork-upswererequested. IntheAPgraphofthecaseinwhichthefracturelinecouldnotbe observedintheobliquegraph,unicondylarfractureswereobserved intheproximalsectionofthesecondandthirdproximalphalanges (Fig.1aandb).Surgicaltreatmentwasnotplannedbecause10days

hadpassedsincethetrauma,becauseoftheriskofadhesionand stiffnessofthejointregardingtodelayedsurgery.Aftersplinting, whichincludedthefingertip,andplacingthemetacarpophalangeal jointat70◦andtheinterphalangealjointatextension,weekly con-trolswerescheduled.Inthecontrolgraphstakenafter3weeks, healingatthefracturesitewasobserved,andhewasreferredto physiotherapyfor4weeksaftertheremovalofthesplint.(Fig.2a

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96 B.Kömüretal./InternationalJournalofSurgeryCaseReports24(2016)94–96

andb).Followingphysiotherapy,itwasobservedthatthepower ofclutchingwasalmostcomplete,andhehadnocomplaintother thanmildpainwhileformingafist(Fig.3aandb).

3. Discussion

Condylarfracturesofphalangesofhandarecommonly encoun-tered.Suchinjuriesarecommonlyseeninyoungerpatients[1].The treatmentisnoteasyinthesetypeoffractures.Surgicaltreatment ofthesetypeoffracturesarecanbeconsideredwhenthefragment islargeanddisplacedfromthejoint.Becauseoftheextensionof tendonsisimportantoverthebone,thegoalofthetreatmentisnot onlytohealthefracture,butalsotopreservetheslidingmechanism ofthesetendons[2].Whenthefractureisappropriatelyreduced, fixationofthefracturecanbeachievedbysplintingand stabiliz-ingeffectofthesofttissues.Openreductionandinternalfixation isanotheroption;however,itcanleadtotheimpairmentofthe slidingmechanismoftendonsoversofttissue.Surgicaltreatment shouldbecommonlychoseninopenfracturesthatareunstable, whichare not easily-reducedand have withsofttissue trauma [3,5].Becauseofthelackofsofttissuetrauma,favoredjoint move-mentsafterthehealingofthefracturecanbeachievedmoreeasily withconservativetreatment;however,thefracturemustbeclosely followedup[6].

4. Conclusion

Condylarfracturesofproximalphalanges,whicharenot dis-placed,canbeconservativelytreated withclosedmethods.This enablesthehealingofthefracturewithouttheoccurrenceof addi-tionalsoft tissue trauma.Surgicaltreatment canbe chosen for displacedfracturesandopenfractureswithsofttissueloss. Conflictofinterest

None. Funding None.

Ethicalapproval

Ourstudyisacasereport,thusweobtainedconsentformfrom thepatient.

Consent

Writteninformedconsentwasobtainedfromthepatientfor publicationofthis casereportandanyaccompanyingimages.A copyofthewrittenconsentisavailableforreviewbythe Editor-in-Chiefofthisjournal.

Authorscontributions

BKwriting,datacollection,OGdataanalyze,SMediting,BY ref-erences,BYdataprocessing,writing,TDdataprocessing.

Guarantor BaranKomur. References

[1]D.J.Shewring,A.C.Miller,A.Ghandour,Condylarfracturesoftheproximaland

middlephalanges,J.HandSurg.Eur.40(2015)51–58.

[2]S.Jehan,T.Chandraprakasam,S.Thambiraj,Managementofproximal

phalangealfracturesofthehandusingfingernailtractionandadigitalsplint:a

prospectivestudyof43cases,Clin.Orthop.Surg.4(2012)156–162.

[3]M.W.Fok,W.Y.Ip,B.K.Fung,R.K.Chan,S.P.Chow,Ten-yearresultsusinga

dynamictreatmentforproximalphalangealfracturesofthehands,

Orthopedics36(2013)348–352.

[4]M.A.Sirota,B.G.Parks,J.P.Higgins,K.R.MeansJr.,Stabilityoffixationof

proximalphalanxunicondylarfracturesofthehand:abiomechanicalcadaver

study,J.HandSurg.Am.38(2013)77–81.

[5]D.Ozc¸elik,G.Toplu,T.Unveren,F.Kac¸a˘gan,C.G.Senyuva,Long-termobjective

resultsofproximalphalanxfracturetreatment,Ulus.Travma.Acil.Cerrahi.

Derg.17(2011)253–260.

[6]A.R.Koul,R.K.Patil,V.Philip,Tractionsplints:effectivenonsurgicalwayof

managingproximalphalanxfractures,J.Trauma66(2009)1641–1646.

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