The S Quattro: a new system for the management of difficult intra-articular fractures of the phalanges.

Fractures of the phalanges of the fingers are common injuries. The average accident and emergency department will see several hundred each year (Benke & Stableforth, 1979). Causal factors include falls, road traffic accidents and commonly sport, especially football and cricket (Barton, 1977). About 18% of all phalangeal fractures extend into a joint, usually the proximal interphalangeal joint and 8% are associated with comminution (Barton, 1984). Such injuries are associated with considerable morbidity, the main problem being stiffness and deformity. Fractures involving the proximal interphalangeal joint for example often lead to dorsal subluxation of the base of the middle phalanx. Although they are stable in flexion, it is undesirable to immobilize the joint in this way as stiffness will result (James, 1970). The stiffness is a particular problem with the proximal joint whose normal range of movement exceeds that of the distal interphalangeal joint contributing considerably to the grip strength. Displaced comminuted phalangeal fractures or intra-articular fractures, especially where more than 40% of the joint surface is involved, present the greatest difficulties. Even if immobilized in extension, the finger may become stiff in extension later. Early mobilization is appropriate for minor avulsions and other stable fractures but for the more complicated injuries, a more aggressive approach