Figure 0063106S

Figure Legend: Unstable phalangeal fractures follow a predictable course regarding three complications. First, dorsal-palmar angulation of mid shaft phalangeal fractures occurs due to asymmetric pull of muscle tendon units.  Proximal phalanx fractures typically fall into a dorsal concave ("apex volar") angulation. Second, failure of reduction often results in complete recurrence of fracture deformity.  Third, tendon imbalance due to malunion in angulation results in joint contractures distal to the fracture equal in magnitude and opposite and direction as the malunion. The top radiograph demonstrates initial angulation of such a fracture.  The fracture was reduced and stabilized with Kirschner wires, but redisplaced after the original surgeon removed the fixation. The bottom radiograph demonstrates the healed malunion, complete recurrence of the initial deformity, with a flexion contracture of the proximal interphalangeal joint equal in degree to the angle of malunion.
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