Related Experiment Video
Updated: May 3, 2026
Treatment of Facial Deformities using 3D Planning and Printing of Patient-Specific Implants
Published on: May 23, 2020
A stepwise algorithm for surgical treatment of type II displaced pediatric phalangeal neck fractures
Jonas L Matzon1, Roger Cornwall1
1Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
This study evaluated a stepwise algorithm for treating pediatric phalangeal neck fractures. The approach achieved excellent results, minimizing the need for open reduction in displaced fractures.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Displaced phalangeal neck fractures in children can lead to long-term functional deficits.
- Effective reduction and fixation techniques are crucial for optimal outcomes.
Purpose of the Study:
- To assess a stepwise reduction algorithm for pediatric phalangeal neck fractures.
- To evaluate the efficacy of closed reduction, percutaneous reduction, and open reduction techniques followed by percutaneous pin fixation.
Main Methods:
- A consecutive series of 61 children with displaced phalangeal neck fractures were treated.
- A stepwise algorithm involving closed reduction and percutaneous pinning (CRPP), percutaneous reduction and pinning (PRPP), or open reduction and percutaneous pinning (ORPP) was employed.
- Radiographic and clinical outcomes were graded using the Al-Qattan system.
Main Results:
- All 61 fractures achieved satisfactory alignment without requiring open reduction.
- CRPP was successful in 49 cases, and PRPP in 12 cases.
- 92% of patients achieved good to excellent outcomes, with 45 excellent and 4 good results.
Conclusions:
- The stepwise algorithm effectively treats pediatric phalangeal neck fractures.
- This approach minimizes the need for open reduction, even in late-presenting cases.
- High rates of good to excellent functional recovery were observed.
Purpose:
To evaluate a stepwise reduction algorithm including closed, percutaneous, and open reduction techniques followed by percutaneous pin fixation for displaced pediatric phalangeal neck fractures.
Methods:
Sixty-one consecutive children (mean age, 9.4 y; range, 2-18 y) presenting with closed, type II displaced phalangeal neck fractures were treated using the following algorithm. If satisfactory reduction was achieved with closed reduction, percutaneous pinning (CRPP) was performed. If not achieved, then percutaneous reduction and pinning (PRPP) was performed using a temporary intrafocal joystick for reduction and for osteoclasis as needed. If percutaneous reduction failed, open reduction and percutaneous pinning (ORPP) was performed. Using the Al-Qattan system, radiographic and clinical outcomes were retrospectively graded for union, deformity, range of motion, and function.
Results:
Satisfactory alignment was achieved in all 61 fractures, by CRPP in 49 and PRPP in 12. No fracture required open reduction. Mean number of days from injury to surgery was 8 days for CRPP and 17 days for PRPP. All fractures treated after 13 days required percutaneous pinning. Fifty-three patients were followed for at least 1 year or until full functional recovery was achieved, with 45 excellent, 4 good, 1 fair, and 3 poor results. Four complications accounted for the fair and poor results, including 1 flexion contracture, 1 nonunion following pin track infection, and 1 case of avascular necrosis following a severe crush injury in the CRPP group and 1 flexion contracture following PRPP.
Conclusions:
Our stepwise algorithm for surgical treatment of closed, type II displaced pediatric phalangeal neck fractures produced 92% good to excellent results while minimizing the need for open reduction even in late-presenting fractures.
Type Of Study/Level Of Evidence:
Therapeutic IV.
