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Condylar Fractures

Taylor had an injury to his small finger as he was playing basketball. Initially his coach and family thought he had “jammed” the finger. Because the pain continued, he was sent for an x-ray by his pediatrician. The x-ray showed a nondisplaced fracture across the distal end of his proximal phalanx. Everyone was relieved. He used a finger splint, but after 2 weeks it seemed his finger had an odd appearance. Repeat x-rays showed the fracture now to be completely displaced into an unsatisfactory position. Everyone panicked.

What is a condylar fracture?

Condylar fractures involve the joint surfaces of the finger bones. The most common are seen in the proximal phalanx. Usually as the result of a sports injury caused by axial load combined with lateral angulation of the finger. They tend to be very unstable and frequently require operative intervention. If conservative treatment is attempted, secondary displacement, leading to angulation of the finger, often occurs.

How are condylar fractures diagnosed?

Because the finger may have an almost normal appearance, families presume that the joint was sprained or jammed. If the pain persists beyond a couple of days there is concern for a condylar fracture. The swelling around the joint may obscure the true boney deformity so x-rays are required.

How are condylar fractures treated?

In the rare case that is treated without surgery, a cast might be effective but requires regular follow-up x-rays performed on a weekly basis to detect early changes in alignment. For the vast majority of condylar fractures, early operative treatment yields the best result. This often means pinning the fracture before displacement has occurred since most fracture fragments will “fall off” resulting in deformity. A small screw can be used rather than pins. Both are day surgery (outpatient) procedures.

Protection with a cast is used for 3-4 weeks. Pins are easily removed in the office. Screws are usually left implanted.

What is the long-term outlook for my child?

After a short course of hand therapy most children resume normal activity levels with no pain or deformity within 6 to 8 weeks. Very rarely the fracture fragment loses its blood supply because of the injury yielding a longer course of reconstruction and therapy.

Taylor and his family were seen in the office of the pediatric hand specialist who recommended that a trip to the operating room would be required. There the malalignment was corrected and a pin was placed. After the pin was removed he worked hard to regain his motion. His success was complete as he led his team to the junior state finals.