Proximal phalanx shaft fracture with entrapment in the transverse retinacular ligament: a case report

Devan O. Higginbotham, Andrew G. Tsai


We report the interesting case of a 33 years old male who underwent operative intervention for a left oblique proximal phalanx shaft fracture of the third finger which penetrated the transverse retinacular ligament (TRL). This patient required operative intervention due to entrapment of the bony fragment in the TRL which acted as a noose with traction on the fractured segment. The fracture was irreducible through a closed maneuver. The use of a dorsal approach allowed visualization of the fracture site and implementation of screws for fixation was deemed adequate secondary to the patient’s bone quality. He was placed in a volar splint at the conclusion of the case to allow for immobilization and protection of the repair. At follow-up, the patient’s radiographic images appeared appropriate and was progressing as expected. We report lessons learned from this case and describe a previously unreported fracture pattern and a possible method of reduction and fixation through a surgical approach in this report.


Irreducible oblique phalangeal shaft fracture, Transverse retinacular ligament, Entrapment, Hand

Full Text:



Karl WJ, Olson PR, Rosenwasser MP. The Epidemiology of Upper Extremity Fractures in the United States, 2009. J Orthop Trauma. 2015;29:242-4.

Lee YK, Lee JM, Lee M. Finger Snapping due to Retinacular Ligament Injury at the Level of Proximal Interphalangeal Joint. Medicine. 2015;94(24):996.

Logters TT, Lee HH, Gehrmann S, Windolf J, Kaufman RA. Proximal Phalanx Fracture Management. Hand. 2018;13(4):376-83.

Honeycutt PB, Jernigan EW, Rummings WA, Stern PJ, Draeger RW. Volar Anatomy of the Proximal Phalanx: Implications for Screw Length Selection for Fixation of Shaft Fractures. J Hand Surg Am. 2017;42(3):149-57.

Cowen NJ, Kranik AD. An Irreducible Juxta-epiphyseal Fracture of the Proximal Phalanx: Report of a case. Clin Orthopaedics Related Res. 1975;110:42-4.

Yamane T. Irreducible Juxta-Epiphyseal Fracture due to Entrapment of Extensor Hood: A Case Report. Hiroshima J Med Sci. 1999;48(3):99-100.

Gaston RG, Chadderdon C. Phalangeal Fractures: Displaced/nondisplaced. Hand Clin. 2012;28:395-401.

Henry MH. Fractures of the Proximal Phalanx and Metacarpals in the Hand: Preferred Methods of Stabilization. J Am Academy Orthopaedic Surg. 2008;16(10):586.