Pediatric Proximal Phalanx Fractures

Abstract

Background The outcomes literature on proximal phalanx fractures in children is sparse. The purpose of this study is to report the complications and outcomes of displaced proximal phalanx fractures after treatment with closed reduction and percutaneous pinning. Methods A retrospective chart review identified 105 patients treated with closed reduction and percutaneous pinning of displaced proximal phalanx fractures. Specific complications were recorded for all patients. Thirty-one of these patients returned more than 1 year after surgery for assessment including visual analog scales of pain level, functional ability, and aesthetics. Objective measurements included range of motion, grip and pinch strength, and finger deformity. Radiographs were taken to assess deformity. Results Five of the 105 patients (4.8%) had a complication including infection, pin site complication, or malunion. Thirty- six had stiffness and 31 ultimately underwent hand therapy to regain motion. Subcondylar fractures were associated with a greater likelihood of stiffness. In the 31 patients returning for assessment, the median visual analog scale score was 0 for pain (none), function (full), and aesthetics (perfect). Range of motion, grip, and pinch strength were equivalent to the contralateral side. Seven of the 31 patients (22.6%) had a measureable coronal plane deviation averaging 5° (range 3°-13°) on radiographs. Deviation was associated with subcondylar fractures and a worse aesthetic VAS. Deviation was not associated with worse outcomes overall. Conclusions Pediatric patients with a displaced proximal phalanx fracture treated with closed reduction and percutaneous pinning have an initial notable complication rate related to stiffness; subcondylar proximal phalanx fractures are more commonly affected. At greater than 1 year follow up, patients had full motion, no pain, and were happy with both function and appearance despite minor deformity in some. These complication data may help better inform patients and families prior to surgical intervention.

Fractures of the base of the proximal phalanx in children: comparison between cast immobilization and Kirschner wire fixation

“…The preoperative clinical and radiographic data of the two groups of patients were comparable, and it is possible that multiple attempts to percutaneously fix such injuries, may have contributed to higher rate of malunion and pain (iatrogenic) in patients treated surgically. Boyer et al [8] also found that pediatric patients (n = 105) with displaced FBPP managed by percutaneous pinning have a notable complication rate related to the stiffness. In this study, we also found one patient had malunion and developed mild pain following CRPP.…”

“…Treatment of FBPP in children remains debated. Following closed reduction, some authors recommend the use of Kirschner wires (K-wires) to restore the finger’s maximal range of motion (ROM) and maintain reduction [8,9], while others report that cast immobilization may be enough because of the significant remodeling potential in children [1,3,10].…”

Clinical outcomes of closed, displaced phalangeal neck fractures in children with different types of kirschner wire fixation: A retrospective observational study

“…Many researchers believe that phalangeal fractures in children have strong bone shaping ability and do not require anatomical reduction. In clinical practice, it is not rare for patients with inaccurate fracture fixation and fracture displacement to obtain conservative treatment (11,(13)(14)(15)(16)(17). The phalangeal head in children is primarily cartilaginous and has no tendon attachments.…”

“…The phalangeal head in children is primarily cartilaginous and has no tendon attachments. Once the fracture of the phalanges neck is displaced or rotated, it will eventually lead to malunion, often causing finger deformity and joint rigidity, and affecting function (13)(14)(15)18). Therefore, for children whose fingers are angulated, rotated, limited in function, unable to cooperate, and have poor compliance, more doctors are recommending the use of internal fixation (11,19).…”

Floating proximal interphalangeal joint (PIPJ) injury of the little finger in a child: A case report

“…Management of isolated proximal phalangeal neck fractures is controversial with few studies suggesting Closed reduction and pinning [ 9 ] with most requiring formal hand physiotherapy. Similar outcomes between non-operative and operative methods of fixation [ 10 ] have been suggested, when dorsal extension block splinting has been elected as a definitive treatment for these injuries.…”