Proximal and Middle PhalangesIntraarticular Fractures Condylar fractures: single, bicondylar, osteochondral They require anatomic reduction; ORIF should be performed for >l mm displacement. Comminuted intraarticular phalangeal fractures should be treated with reconstruction of the articular surface, if possible. Severely comminuted fractures that are deemed nonreconstructible may be treated closed with early protected mobilization.P.265

Fracture-Dislocations Volar lip fracture of middle phalangeal base (dorsal fracture-dislocation) Treatment is controversial and depends on percentage of articular surface fractured: Hyperextension injuries without a history of dislocation with 25% of the articular surface. Various closed pinning techniques are possible, but the mainstay is extension block pinning. Volar Lip This is associated with flexor digitorum profundus rupture (jersey finger: seen in football and rugby players, most commonly involving the ring finger). Treatment is primary repair, especially with large, displaced bony fragments.Extraarticular Fractures These are transverse, longitudinal, and comminuted (nail matrix injury is very common). Treatment consists of closed reduction and splinting. The splint should leave the PIP joint free but usually needs to cross the distal interphalangeal (DIP) joint to provide adequate stability. Aluminum and foam splints or plaster of Paris are common materials chosen. CRIF is indicated for shaft fractures with wide displacement because of the risk for nonunion.

From Bucholz RW, Heckman JD, Court-Brown C, et al., eds. Rockwood and Greens Fractures in Adults, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2006.)

IntussusceptionInvagination of one loop of intestine into another is rarely encountered in adults and is usually caused by a polyp or other intraluminal lesion. Intussusception is more often seen in children; an organic lesion is not required, and the syndrome of colicky pain, passage of blood per rectum, and a palpable mass (the intussuscepted segment) is characteristic.