Avulsion fractures from the base of phalanges of the fingers

Avulsion fractures of the phalanges are among challenging problems encountered in the hand surgery. These fractures are characterized by existence of small bone fragments usually attached to a collateral ligament. They mostly occur in metacarpophalangeal and proximal interphalangeal joints. Bony gamekeeper's thumb is one of the well-known. Inadequate reduction and healing of these fractures may lead to joint deformity, chronic instability and posttraumatic arthritis. Existence of very small bone fragments and involvement of joint surface are the obvious factors predisposing to technical problems in reposition and fixation of these fractures. Avulsion fractures are intraarticular according to their configuration and need anatomic reduction. AO principles depending on stable fixation and compression have difficulties to be applied to these fractures owing the inconvenience of the osteosynthesis materials and implants available are designed for fracture fixation of larger bones. Fixation may result in further comminution of the fragments.