Spiral Oblique Phalangeal Fractures with Butterfly Fragments

Abstract

When a butterfly fragment is present, a three-part fracture exists, and the problems of reduction and fixation become more challenging than with the spiral oblique fracture only. Each side of the butterfly must be fixed to its adjacent fragment before the reduction will be stable. Occasionally, it is possible to get more than one screw into each side of the butterfly fragment (Figs. 26-1 A-G), but this is not common in such small bones as the phalanges. If possible when only one screw can be inserted, it should be positioned to bisect a perpendicular to the fracture and a perpendicular to the long axis of the bone. A neutralization plate is used to protect the two screws from rotational forces (Figs. 26-2 A-K). Where there is more comminution and fragments are small, the ideal fixation techniques cannot be used. The ingenuity of the surgeon is taxed by such situations, and this is where interosseous wiring and tension band techniques may save the day. Although compression may be impossible, fixation may be stable and the overall result may be correspondingly improved.