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Phalangeal neck fractures in children: classification and outcome in 66 cases
1Division of Plastic Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia.
Insights
Phalangeal neck fractures in young children, often caused by door or swing entrapment, require prompt management. K-wire fixation is crucial for optimal outcomes in displaced Type II fractures, unlike undisplaced Type I fractures managed with splinting.
Area of Science:
- Orthopedic surgery
- Pediatric hand fractures
- Traumatology
Background:
- Phalangeal neck fractures are common in young children.
- Entrapment injuries (doors, swings) are the primary cause.
- Fracture classification impacts treatment and prognosis.
Purpose of the Study:
- To analyze outcomes of phalangeal neck fractures in children.
- To evaluate the effectiveness of different management strategies.
- To identify factors influencing fracture healing and patient outcomes.
Main Methods:
- Retrospective review of 67 phalangeal neck fractures in 66 children.
- Classification of fractures into Type I, II, and III based on displacement and bone contact.
- Analysis of treatment methods (splinting, K-wire fixation) and their correlation with outcomes.
Main Results:
- Type I fractures (undisplaced) treated with splinting showed excellent results.
- Type II fractures (displaced, some bone contact) had significantly better outcomes with K-wire fixation compared to non-fixation.
- Type III fractures (displaced, no bone contact) often failed to unite with inadequate treatment.
Conclusions:
- Early and appropriate management is critical for pediatric phalangeal neck fractures.
- K-wire fixation is recommended for displaced Type II fractures to ensure union and good functional outcomes.
- Undisplaced Type I fractures can be effectively managed non-operatively with splinting.
Abstract:
A series of 66 children with 67 phalangeal neck fractures in the hand is presented. Young children (1-3 years of age) made up 44% of the series. The mechanism of injury was entrapment of the digit in a closing door or a swing in almost all cases. Type I fractures (n = 13) were undisplaced and treatment with a splint resulted in excellent results in almost all cases. Type II fractures were defined as displaced fractures with some bone-to-bone contact. There were 47 Type II fractures and the outcome was significantly affected by the method of initial management. Fractures treated without K-wire fixation had a significantly worse outcome than those who underwent K-wire fixation. Type III fractures (n = 7) were displaced with no bone-to-bone contact. If inadequately treated, these fractures did not unite.