Fractures of the distal interphalangeal joint.

Fractures at the distal interphalangeal joint present a therapeutic challenge to the hand surgeon because of the relatively small bones and joint surfaces involved and the limited internal fixation devices available. Knowing which patients and which fractures are best treated surgically is key to a successful result. The normal anatomy and biomechanics of the joint are outlined and overviewed and the anatomy, etiology, therapy, and classification are discussed. Comminuted fractures of the articular surface of the distal phalanx are presented as are epiphyseal fractures of the distal phalanx. Avulsion of the profundus tendon (jersey finger) is discussed, emphasizing Leddy and Packer's Types I, II, and III injuries and the recommended treatment. Condylar fractures of the articular surface of the middle phalanx at the distal interphalangeal joint are the subject of the next section, with London's classification scheme and recommended treatment. Finally, complex open injuries and replantation through the distal interphalangeal joint are presented with guidelines for salvage and treatment.