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Closed type III phalangeal neck fractures with 180-degree rotation is a rare iatrogenic injury that occurs following failed attempts at closed reduction. Prior to closed reduction, the phalangeal head is in 90-degree rotation. Longitudinal traction during closed reduction then converts the deformity into 180-degree rotation. We present the first documented noniatrogenic case of phalangeal neck fracture with 180-degree rotation which was also associated with a displaced Salter-Harris II fracture at the same joint. The blood supply of the phalangeal head in that scenario is discussed along with precautions that should be taken during open reduction and internal fixation to avoid avascular necrosis of the phalangeal head.
(C) 2012 Lippincott Williams & Wilkins, Inc.

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