Proximal interphalangeal joint hyperextension injuries in children

Proximal interphalangeal joint (PIPJ) hyperextension injuries are common in children. There is a range of opinion on management but little evidence to suggest best practice.

To determine from a convenient sample size, the overall and significant fracture rate. Whether significant injuries can be differentiated from the insignificant clinically and whether children get complications.

Data were collected on all PIPJ hyperextension injuries (thumb excluded) presenting to a children's emergency department between October and December 2006. Staff were trained to perform standardised assessment and documentation and all injuries were x rayed. The diagnosis was cross-referenced with x ray reports. All notes were reviewed for 4 months. Management, complications and unscheduled returns were noted.

From the population of 134 patients, there was a fracture rate of 55% (74/134). Of those, 57% (42/74) were defined as significant. Others included buckle (9/74), flake (14/74) and avulsion (9/74) fractures. Obvious deformity and inability to touch pulp to palm were significantly associated with a fracture. Except for those with clinical deformity requiring manipulation, all injuries were treated conservatively. There were no unscheduled returns with any complications 4 months post-injury.

There is a significant risk of a fracture in children sustaining hyperextension injuries to the PIPJ. These results show that, except in those with an obvious deformity, it is difficult to differentiate clinically between those with a sprain, minor or significant fracture. Even those with a significant fracture were managed conservatively. Children appear not to have the complications seen in the adult population with similar injuries.