Supraintercondylar fracture of the proximal phalanx of the hallux

Abstract

Toe phalanx fractures are prevalent worldwide. The proximal phalanx of the hallux requires different treatment from the other four lateral phalanges. Poor positioning of rotation and angulation is not acceptable for this bone, since it can result in significant functional deficit. Indications for surgical treatment are: joint fractures with deviations greater than 2 mm, metadiaphyseal fractures with rotational and/or angular deviation, open fractures and unstable fractures. The classic medial approach in surgical treatment involves some high-risk neurovascular structures and does not allow the correct positioning of osteosynthesis systems in some cases. The aim of this study is to present an option for the surgical treatment of deviated and unstable supraintercondylar fractures of the proximal phalanx of the hallux by the dorsolateral approach, with a traction screw through the plate and a lateral neutralization plate. Level of Evidence V; Therapeutic Study; Expert Opinion.

Hallux Proximal Phalanx Fracture in Adults: An Overlooked Diagnosis

“…It is performed medial to the vessels and lateral nerves of the hallux and no ligament or tendon detachment is necessary. 29 Both dorsomedial and dorsolateral approach using L-shaped incision present higher risk for soft tissue blood supply compared to other approaches using straight incisions. 6,9 Direct reduction should be performed using a periosteal elevator as a lever to reduce the fracture.…”

“…Once the fracture is adequately reduced, a Kirschner wire (K-wire) is used, so the clamp can be removed, thus facilitating plate positioning. 5,6,9,29 (Figure 2)…”