Outcomes of Phalangeal Neck Fractures in a Pediatric Population

Abstract

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.

Corrective osteotomy for distal condylar malunion of the proximal phalanx in adolescents: comparison of K-wire and locking plate fixation

“…A few recent studies have proposed non-operative treatment alternatives for management of some cases of Type II, and even Type III fractures (Park et al., 2016; Tan et al., 2020). We do not know the exact rate of deformity progression with inadequate non-operative treatment, as our institute generally follows the principles proposed by Al-Qattan and Al-Qattan (2015).…”

“…The preoperative, immediate postoperative and final radiographs were measured on the picture archiving and communication system (PACS) system. The head-shaft angulation and translation were assessed on both coronal and sagittal views (Tan et al., 2020) (Figure 4). In unicondylar fractures, parameters were measured on the displaced fragment.…”

Fractura osteocondral abierta del penacho de la falange distal en punta de dedo en niños: una lesión frecuentemente no diagnosticada

“…En 2001, Al-Qattan 24 propuso una clasificación para otro tipo de fractura osteocondral en niños al publicar una serie de fracturas en el cuello de la falange de la mano, un sitio poco frecuente de fracturas en adultos. Por su parte, Tal et al 25 señalaron que estas lesiones son más frecuentes en la falange media de los niños, demostraron que el fragmento distal puede presentar diferentes grados de desplazamiento y rotación y evidenciaron que con frecuencia se requiere cirugía para su tratamiento.…”

What’s New in Hand and Wrist Surgery

“…If malrotation is not present, extra-articular phalangeal neck fractures in children remodel and have good functional outcomes without a surgical procedure 73,74 . Liao et al 75 compared cast immobilization (19 patients) and hand or finger-based splint immobilization (28 patients) for phalangeal neck fractures.…”