Fractures of the Great Toe Proximal Phalanx: A Case Series and Review of the Literature

Phalangeal fractures are the most common fractures seen in the foot, especially in the great toe. Acceptable angulations for fractures of the proximal phalanx are not known. To determine practice trends, a retrospective review of consecutive patients treated at a single institution from January 2011 to August 2014 was performed. All patients were skeletally mature with fractures to the diaphysis of the proximal phalanx with or without intra-articular extension. Outcomes from the medical record review included the type of treatment, radiographic alignment, and visual analog pain scores. Of the 12 patients reviewed, 4 sustained crush injuries and 8 sustained axial load injuries. Statistical analysis was done using Student’s t test for a normally distributed population. Nine of the 12 fractures were treated with manipulation, 7 were closed reduction and percutaneous pinning (CRPP), and 2 were isolated closed reduction without internal fixation. Two of the 9 patients with CRPP required additional surgery. The comparison between the sagittal plane angulation in the closed reduction cohort was 25 degrees compared with 42 degrees in the CRPP cohort (P=0.02). The final sagittal plane angulation comparison was not significant 12 versus 15 degrees (P=0.55). In the transverse plane, no statistical difference was seen between the 2 cohorts with an initial angulation of 8 degrees in the closed reduction cohort versus 13 degrees in the CRPP cohort (P=0.45). The final transverse angulation was symmetric with a mean of 4 degrees in each cohort (P=0.91). The patients in this review were more likely to be treated with operative intervention when initial angulation had a mean of 42 degrees in the sagittal plane. Patients with initial mean angulation of 25 degrees were more likely to be treated with a closed reduction. Final sagittal plane angulations of 12 to 15 degrees were associated with good outcomes. This series may help surgeons and patients in their shared decision making when faced with shaft fractures of the proximal phalanx. Level of Evidence: Level IV—retrospective cohort study.