A treatment approach for isolated unicondylar fractures of the proximal phalanx

We developed a protocol to improve the final total active motion for patients with isolated unicondylar fractures of the head of the proximal phalanx. The protocol includes surgical treatment followed by hand therapy. Surgical fixation is obtained using lag screw technique. Therapy includes immediate mobilization by use of a continuous passive motion machine and controlled active motion. Specially designed splints and Coban wrap are used to control the position of the digit during the first six months following surgery. Silastic gel is used to control scarring. We treated five consecutive patients over a 4-year period using this protocol. Final total active motion of the injured digit averaged 241 degrees--approximately 90% of the normal range of 260 to 270 degrees. No patients required secondary surgery.