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[A new technique of intrafocal pinning for phalangeal neck fractures in children]
1Service de chirurgie plastique et réparatrice des membres, chirurgie de la main, hôpital de la Conception, 147 boulevard Baille, Marseille cedex 05, France. londnerjonathan@hotmail.fr
Insights
Intrafocal pinning offers excellent results for displaced phalangeal neck fractures in children. This minimally invasive technique achieves good anatomical outcomes with limited soft tissue damage, making it a preferred treatment option.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Phalangeal neck fractures are uncommon, primarily affecting pediatric patients.
- Assessing treatment outcomes for these fractures is crucial for pediatric orthopedic care.
Purpose of the Study:
- To evaluate treatment results for phalangeal neck fractures in children.
- To introduce and assess a novel intrafocal pinning technique for displaced fractures.
Main Methods:
- A cohort of 49 children (52 fractures) aged 3 months to 14 years were treated between 2001 and 2007.
- Undisplaced fractures were managed non-operatively; 13 displaced fractures underwent intrafocal pinning.
- Standard osteosynthesis was used for open or complex displaced fractures.
Main Results:
- Intrafocal pinning yielded excellent results in 11 of 13 cases and good results in 2.
- No infections, tendon ruptures, osteonecrosis, or nonunions were observed with this technique.
- One case required reoperation for delayed consolidation of a proximal phalanx thumb fracture.
Conclusions:
- Percutaneous reduction and intrafocal pinning demonstrate superior outcomes for displaced phalangeal neck fractures.
- The technique facilitates effective percutaneous reduction and fixation, minimizing soft tissue disruption.
- Open fractures are associated with a less favorable prognosis.
Introduction:
Phalangeal neck fractures are unusual, occurring mainly in children. This study aims at assessing the results of treatment of this type of fracture and presents a new technique for displaced fractures namely intrafocal pinning.
Patients And Methods:
From January 2001 to January 2007, we treated 49 children (32 boys and 17 girls) with 52 phalangeal neck fractures. The patients were aged between three months and 14 years (average seven years). Five fractures were open but without nerve, artery or tendon damage. The 32 undisplaced or minimally displaced fractures were treated by closed methods. Thirteen displaced fractures (of which three were secondary displacements) were treated with an intrafocal pinning technique inspired by the Kapandji technique for distal radius fractures. Seven fractures (five open and two closed but displaced) were treated using standard osteosynthesis techniques (temporary arthrodesis, crossed K wires or cerclage).
Results:
We reviewed the patients an average of 18 months later. We classified the results according to Barton's classification: excellent, good, fair and bad. Among the 13 fractures treated with an intrafocal pinning technique, 11 gave excellent results and two gave good results. We did not find any infection, tendon rupture, phalangeal head osteonecrosis or nonunion. We had to reoperate on one proximal phalanx thumb fracture because of delayed consolidation.
Discussion:
Percutaneous reduction of the displacement and pinning seems to give the best results for the treatment of displaced fractures. The surgeon aims at getting the best anatomical result whilst limiting soft tissue damage. The proposed technique seems to give good results as it allows a percutaneous reduction of the displacement and an effective means of holding the reduction. Open fractures have a poorer prognosis.
