Purpose Displaced pediatric phalangeal neck fractures are regarded as unstable, and hence, surgical fixation is traditionally recommended. In our experience, some patients with displaced fractures treated nonsurgically healed with a good clinical outcome and no further displacement. We studied the outcome of displaced phalangeal neck fractures treated nonsurgically with attention to the change in fracture displacement over time and hypothesized that displaced phalangeal neck fractures can be treated nonsurgically with maintenance of acceptable radiological parameters.Methods A retrospective review of 35 patients aged 16 and younger was conducted. Included patients had at least 10 of angulation or 25% translation in either the coronal or the sagittal plane, with no malrotation. Angulation and translation of the distal fracture fragment in the coronal and sagittal planes was measured from radiographs taken at 2 intervals-within 7 days of the injury and at least 21 days after the injury. Initial and final measurements were compared to determine the amount of fracture displacement that occurred.Results Thirty-five patients with type II A, B, and C fractures (classification according to Al-Qattan) comprised our study sample. Twelve patients had undergone manipulation and reduction. Average radiological follow-up was 4.3 months (range, 0.7e86 months; median, 1.2 months; SD, 14.7). These fractures treated nonsurgically did not displace as the fracture healed, suggesting that type II fractures, although traditionally regarded as unstable, may maintain their radiological parameters without surgical fixation.Conclusions Our findings suggest that displaced phalangeal neck fractures do not necessarily displace with nonsurgical treatment.
Background: Phalangeal neck fractures account for 13% of pediatric finger fractures. Al Qattan type I (undisplaced) fractures are treated nonoperatively. There is increasing evidence that Type 2 (displaced) fractures achieve remarkable fracture remodeling with nonoperative treatment and patients frequently make a full functional recovery. The options available for nonoperative management of these fractures are either a plaster cast or a removable splint. We hypothesized that there would be no significant difference in radiologic outcome in pediatric phalangeal neck fractures (Types I and II) treated with splint or cast immobilization. Methods: This is a retrospective study of patients aged 18 and below with phalangeal neck fractures treated nonoperatively from 2008 to 2017. Radiographs were compared at <1 week and >3 weeks after injury. Translation and angulation in coronal and sagittal planes were measured and compared using Student t tests. Baseline variables were compared using χ2 or Fisher exact tests. Results: There were 47 patients with phalangeal neck fractures treated nonoperatively during the study period. There were 9 type I and 38 type II fractures. The mean age was 10 years with 40 males and 7 females. Fractures occurred in 33 dominant and 14 nondominant hands and involved 29 proximal and 18 middle phalanges. Nineteen children were treated in casts and 28 with removable splints. The mean duration of follow-up was similar between the 2 groups. The most affected phalanx was the proximal phalanx of the small finger and the most common fracture pattern was type IIA. There was no significant difference in clinical and radiologic outcomes between children who were treated in casts and those treated in removable splints. Conclusion: There was no difference in the clinical and radiologic outcomes in pediatric phalangeal neck fractures treated with cast or splint immobilization. Splinting has the added benefits of increased comfort and hygiene and we routinely offer splinting as a viable alternative in the nonoperative treatment of Al Qattan type I and type II phalangeal fractures. Type of Study/Level of Evidence: Level III—therapeutic studies.
Proximal interphalangeal joint (PIPJ) injuries should not be underestimated because they can lead to notable loss of hand function. Treatment of PIPJ injuries should focus on stable, concentric joint reduction to achieve early mobilization. Surgical treatment should be adopted only when the expected outcomes are better than that of nonsurgical treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.