Children’s Proximal Phalangeal Neck Fractures with 180° Rotational Deformity

Newington, D. P.; Craigen, M. A. C.; Bennet, G.C.

doi:10.1016/s0266-7681(05)80093-2

Cited by 22 publications

(25 citation statements)

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“…The incidence of this complication could not be calculated from the current study because the hand unit is a referral centre and the comminution in four of the five cases occurred at other hospitals. Two other iatrogenic complications of these fractures have been discussed in the literature: avascular necrosis of the phalangeal head (1) and flipping of the phalangeal head 180° (8,9).…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally, type III fractures with 90° rotation are seen. Fruitless attempts at closed manipulation with longitudinal traction may open the space at the fracture site enough to allow further displacement of these fractures to 180° rotation (1,9). Therefore, excessive longitudinal traction during reduction of these fractures should be avoided.…”

Section: Discussionmentioning

confidence: 99%

“…Several articles have discussed the various complications associated with these fractures such as vascular injury, malunion, nonunion, avascular necrosis of the phalangeal head, rotational deformity of the digit and extension lag/stiffness of the involved joint (3)(4)(5)(6)(7)(8)(9)(10)(11). A review of the English language literature did not reveal any study on iatrogenic comminution of the phalangeal head during reduction/fixation of phalangeal neck fractures.…”

mentioning

confidence: 99%

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Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures

Al‐Qattan

2012

Canadian Journal of Plastic Surgery

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Phalangeal neck fractures are fractures through the necks of the proximal or middle phalanges of the fingers, or through the neck of the proximal phalanx of the thumb, and occur more commonly in children (1) than in adults (2). Several articles have discussed the various complications associated with these fractures such as vascular injury, malunion, nonunion, avascular necrosis of the phalangeal head, rotational deformity of the digit and extension lag/stiffness of the involved joint (3-11). A review of the English language literature did not reveal any study on iatrogenic comminution of the phalangeal head during reduction/fixation of phalangeal neck fractures. In the present article, we present five cases involving this complication to increase awareness of its occurrence and to increase awareness that such a complication may result in medicolegal claims. MethodsThe author has developed a special interest in phalangeal neck fractures and receives referrals of complicated cases from the central province (population of approximately six million) of Saudi Arabia. A database containing records of phalangeal neck fractures over the past six years was reviewed for iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures. Over the six-year period (2006 to 2011), a total of 152 patients with phalangeal neck fractures were treated. Of these, five cases experienced iatrogenic comminution of the phalangeal head. The following data were documented for these five cases: age, sex, phalanx/digit involved, fracture type, and the presence or absence of ischemia of the fractured digit at the time of injury. Fracture type at the time of injury was documented according to the classification proposed by Al-Qattan (1) as follows: type I are undisplaced fractures; type II are displaced fractures with bone-to-bone contact between the proximal and distal fracture fragments; and type III fractures are displaced fractures with no bone-to-bone contact. Initial and secondary management of these fractures were also documented with particular attention devoted to the causes of comminution of the phalangeal head during management. At final follow-up, the net range of motion of the joints (defined as active flexion minus the extension lag at the same joint) of the fractured digits was recorded. Finally, cases in which medicolegal claims were filed were noted. Table 1 summarizes the results in the five patients studied (two children and three adults). In all cases, the injury was caused by entrapment of the digit in a closing door. None of the fractured digits showed evidence of ischemia at the time of injury. Results Case 1A four-year-old girl presented to hospital with a type III fracture of the middle phalanx of the little finger ( Figure 1A). Open reduction and K-wire fixation was performed through a dorsal approach. There were difficulties in achieving accurate reduction; therefore, the wire was passed through the phalangeal head twice. A longitudinal split of the phalangeal head was noted d...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures

Al‐Qattan

2012

Canadian Journal of Plastic Surgery

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“…They occur most often in younger children in whom they may result from a crush injury typically in the hinge of a door [ 12 ]. A true lateral radiograph of the digit is essential for accurate evaluation.…”

Section: Neck Fracturesmentioning

confidence: 99%

“…Although open reduction is advocated for severely displaced fractures [ 12 ], this is not necessary for the majority. The dorsal periosteum is usually intact and these fractures tend to reduce readily and accurately.…”

Section: Neck Fracturesmentioning

confidence: 99%