Expert opinion review by a high-volume hand trauma surgeon mapping specific proximal phalanx and metacarpal fracture patterns — unicondylar, bicondylar, transverse, spiral, and comminuted — to preferred stabilization strategies. Addresses when to use K-wires, lag screws, or plates, and why the same implant behaves differently at the phalangeal vs. metacarpal level.
When you see a spiral or long oblique proximal phalanx fracture, reach for lag screws (1.3 mm preferred) via a midlateral approach — this pattern offers no fragment contact stability and K-wires will tether the extensor.
When you see a comminuted fracture at any level, plan for a lateral plate as the hardware must be load-bearing, and counsel the patient that functional outcomes will be inferior to simpler patterns regardless of fixation quality.
Expert opinion review by a high-volume hand trauma surgeon mapping specific proximal phalanx and metacarpal fracture patterns — unicondylar, bicondylar, transverse, spiral, and comminuted — to preferred stabilization strategies. Addresses when to use K-wires, lag screws, or plates, and why the same implant behaves differently at the phalangeal vs. metacarpal level.
When you see a spiral or long oblique proximal phalanx fracture, reach for lag screws (1.3 mm preferred) via a midlateral approach — this pattern offers no fragment contact stability and K-wires will tether the extensor.
When you see a comminuted fracture at any level, plan for a lateral plate as the hardware must be load-bearing, and counsel the patient that functional outcomes will be inferior to simpler patterns regardless of fixation quality.