Phalangeal fractures are injuries to the bones of the fingers and toes, commonly resulting from trauma such as falls, sports injuries, or crush-related incidents. Surgical intervention may be required in cases of significant displacement, intra-articular involvement, or when conservative management fails to provide stability or functional recovery. The surgical procedure typically begins with the administration of anesthesia, which can be local or general, depending on the complexity of the fracture and the patient's overall health. The surgeon makes an incision over the affected area to expose the fractured phalanx. Once accessed, the fracture is meticulously examined to assess the degree of displacement and any potential damage to surrounding soft tissues, including tendons, nerves, and blood vessels. If possible, the fragments are realigned to their anatomical position, a process known as reduction, which is crucial for restoring function and healing properly. In cases where the fracture is unstable or does not remain in alignment, internal fixation techniques are employed; this may involve the use of plates, screws, or intramedullary rods to stabilize the fragments. Additionally, external fixation may be used for more complex fractures or in cases where there is an associated soft tissue injury. The fixation devices are carefully positioned to provide adequate support while allowing for some movement and preventing stiffness. Once the fixation is achieved, the incision is thoroughly irrigated to reduce the risk of infection, and the soft tissues are meticulously closed in layers to facilitate optimal healing. Postoperatively, patients are typically placed in a splint or cast to immobilize the affected extremity and protect the surgical site. Pain management, usually with analgesics, is an integral component of postoperative care, alongside instructions for elevation and icing to minimize swelling. Physical therapy may be initiated early to promote range of motion and prevent stiffness, which is particularly important in cases involving the joints. Follow-up appointments are crucial for monitoring the healing process through clinical evaluations and periodic imaging, such as X-rays, to ensure that proper union of the fracture is occurring. Complications, though relatively rare, can include infection, non-union, malunion, or stiffness of the affected digit, which may require further intervention. The overall prognosis for phalangeal fractures treated surgically is generally favorable, with most patients regaining functionality in their fingers or toes, although full recovery may take weeks to months depending on the severity of the injury and the effectiveness of rehabilitation efforts. Ultimately, the aim of phalangeal fracture surgery is to restore both the anatomic alignment of the bones and the functional capabilities of the hand or foot, allowing individuals to return to their daily activities and maintain their quality of life.
