The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Phalangeal Fracture Pearls and Pitfalls

Pediatric phalangeal fractures are extremely common, especially among toddlers and older children/adolescents involved in sporting activities. The physical examination must include an assessment for deviation and malrotation. In addition, concomitant injuries must be assessed for such as tendon and/or neurovascular injuries. Plain radiographs are typically sufficient to make the diagnosis and determine the treatment. The majority of pediatric and adolescent phalangeal fractures can be treated with immobilization. Substantial deviation and malrotation must be addressed with closed reduction techniques with or without percutaneous pinning. Open reduction is reserved for cases with concomitant injuries, open fractures, older adolescents, and patients in whom an adequate closed reduction cannot be obtained. When diagnosed and treated appropriately, pediatric and adolescent phalangeal fractures typically result in excellent outcomes.