The finger fracture which of all others demands most expert mechanical treatment is that of the proximal phalanx. The reputation of a surgeon may stand as much in jeopardy from this injury as from any fracture of the femur.

In the subsequent paragraphs a method is described which I believe to be of value, though it involves a rather heretical doctrine. It is important, therefore, that the spirit of this method should be fully understood because it contains a potential danger if the doctrine is misapplied.

ANATOMY OF THE FRACTURE

Fractures of the proximal phalanx are often compound, because they are so commonly the result of industrial injuries. The characteristic deformity is an angulation concave to the dorsum, and for the purpose of reduction the soft-tissue ‘hinge’ is to be regarded as being on the dorsal aspect of the fracture.

Mechanics of Treatment

The reduction of these fractures as a rule offers no great difficulty; the real difficulty lies in the application of a retentive apparatus which will hold securely the reduction so easily obtained by the surgeon's fingers.

Manipulative reduction is obtained by first applying traction and hyperextension; then, with the thumb applied as a fulcrum to the volar aspect of the fracture, the traction is followed by a movement of flexion, following which the traction is released (Fig. 120). After release of the traction the reduction can be held by a simple three-point arrangement of forces designed to maintain the finger flexed over a fulcrum.