Treatment of closed unstable extra articular proximal phalangeal fractures of hand by closed reduction and dorsal extension block cast

Background: Unstable fractures of proximal phalanges have enormous divergence of opinion regarding the treatment. Treatment options range from fancy over the counter splints to the more exotic forms of internal fixation. Method: A total of 62 cases with 72 fractures with ages from 10-65 yrs of both sexes were treated. After closed reduction under local anaesthesia the dorsal extension block cast was applied with the metacarpophalangeal joints in full flexion and interphalangeal joints in full extension. This method works on the principle of the intact dorsal soft tissue hinge (extensor apparatus) over the fractured proximal phalanx. The intrinsic plus position keeps the intrinsics lax and prevents them from acting as a displacing force pulling the proximal fragment of the fracture into volar angulation. On an average the cast was used for 3 weeks. Results: Fifty eight fractures had united by 3 weeks. The results were judged according to modified Buck-Gramcko′s point assessment system for finger fractures, which showed 80.64% excellent, 4.83% good, 8.06% satisfactory and 6.45% poor results. The complications were minimal which included only 3 cases with malunion. Conclusion: Conservative management of unstable proximal phalangeal fractures with dorsal extension block cast has produced excellent results. It maintains mobility of the fingers without compromising the stability of the fracture and prevents future stiffness of hands. It avoids the complications of operative methods and is simple to use.