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Published on: April 11, 2012
Pediatric phalanx fractures: unique challenges and pitfalls
Roger Cornwall1, Eric T Ricchetti
1Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. cornwall@email.chop.edu
Insights
Pediatric phalangeal fractures require careful evaluation and prompt treatment. Unlike other childhood fractures, these injuries may need surgical intervention to prevent long-term hand deformity and dysfunction.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Pediatric Trauma
Background:
- The hand is the most frequently injured body part in children.
- While most pediatric hand fractures heal well nonoperatively, some require immediate surgical attention.
- Phalangeal fractures in children present unique challenges compared to other pediatric fractures and adult fractures.
Purpose of the Study:
- To review pediatric phalangeal fracture types requiring prompt recognition and surgical intervention.
- To highlight the differences between pediatric phalangeal fractures and other pediatric fractures.
- To emphasize the distinct characteristics of pediatric phalangeal fractures compared to adult fractures.
Main Methods:
- Review of pediatric phalangeal fracture types.
- Emphasis on clinical examination and radiographic evaluation.
- Discussion of potential complications and treatment strategies.
Main Results:
- Phalangeal fractures in children can differ significantly from other pediatric fractures.
- These fractures may require surgical intervention to avoid malunion, deformity, and dysfunction.
- Rapid healing in phalangeal fractures necessitates timely diagnosis and management.
Conclusions:
- Careful clinical and radiographic assessment is crucial for suspected pediatric phalanx fractures.
- Prompt recognition and appropriate treatment are essential to minimize complications.
- Pediatric phalangeal fractures demand specific management strategies distinct from general pediatric fracture care.
Unlabelled:
The hand is the most frequently injured part of the body in children. Most pediatric hand fractures can be treated by nonoperative means with good results. However, a subset of fractures requires prompt recognition and surgical intervention. We will review several pediatric phalangeal fracture types that must be recognized and treated appropriately to minimize complications and disability. These injuries defy the general conception that pediatric fractures universally do well with minimal intervention. This paper highlights two important concepts: (1) phalangeal fractures in children can differ considerably from other pediatric fractures, and (2) phalangeal fractures in children can be very different from those in adults. Tolerance of displacement may be small in juxtaarticular or intraarticular fractures and healing is rapid in phalangeal fractures, allowing displaced fractures to develop into malunions in a short period of time, with resultant deformity and dysfunction. Careful clinical examination of any suspected phalanx fracture in children is essential to appropriate treatment of these potentially problematic injuries, including adequate radiographic evaluation with multiple views of the suspected fracture site and thorough examination of possible open injuries.
Level Of Evidence:
Therapeutic study, level V (expert opinion).
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