Related Experiment Video
Updated: Dec 4, 2025
A Rat Tibial Growth Plate Injury Model to Characterize Repair Mechanisms and Evaluate Growth Plate Regeneration Strategies
Published on: July 4, 2017
Proximal Interphalangeal Hyperextension Injuries in Children: The Development of a Clinical Decision Guide
Christina N Steiger1, Romain Dayer1, Anne Tabard-Fougère1
1Service of Pediatric Orthopedics, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland.
Insights
A clinical decision guide for pediatric hyperextension finger injuries can accurately identify low-risk cases, reducing the need for X-rays. This approach enhances patient care and minimizes unnecessary radiation exposure.
Area of Science:
- Orthopedic Surgery
- Pediatric Emergency Medicine
- Radiology
Background:
- Hyperextension injuries of the proximal interphalangeal (PIP) joint are common in children.
- Accurate diagnosis is crucial to differentiate between minor sprains and significant fractures or dislocations.
- Current diagnostic protocols often rely heavily on radiographic imaging, leading to potential overuse.
Purpose of the Study:
- To develop and evaluate a clinical decision guide for diagnosing and managing acute hyperextension injuries of long fingers in patients under 16 years old.
- To establish high-risk and low-risk indicators for severe injury based on clinical examination and radiographic findings.
- To assess the predictive value of a standardized clinical examination in identifying low-risk injuries.
Main Methods:
- A prospective study included 300 consecutive patients under 16 years with acute PIP joint hyperextension injuries.
- A standardized clinical examination assessed pain location, swelling, bruising, stability, and mobility.
- Radiographs were analyzed for pathological findings, and risk of late complications was assessed.
Main Results:
- The majority of children (67%) presenting with hyperextension finger trauma did not have a fracture.
- No child with a low-risk clinical examination had a subsequent high-risk diagnosis (e.g., intra-articular fracture, dislocation).
- Out of 64 clinically high-risk diagnoses, only 12 significant fractures were identified.
Conclusions:
- A standardized clinical examination protocol can guide treatment decisions for PIP hyperextension injuries.
- The developed clinical decision guide demonstrates 100% sensitivity in ruling out significant injuries.
- Implementing this guide can reduce the number of avoidable radiographs, improve patient care, decrease emergency department wait times, and lower healthcare costs.
Objective:
To develop a clinical decision guide for the diagnosis and treatment of hyperextension injuries of long fingers.
Study Design:
Consecutive patients age <16 years (n = 300) with an acute proximal interphalangeal (PIP) joint hyperextension injury were included. High-risk and low-risk measures for severe injury were established with a standardized clinical examination and anteroposterior and lateral radiographs of the injured finger. Four clinical variables were assessed: location of pain; swelling and bruising, stability, and mobility. Pathological radiographic findings were compiled, and the risk of late complications was analyzed. The predictive value of the clinical examination in the identification of low-risk injuries was assessed.
Results:
The majority (67%) of children consulting for a hyperextension finger trauma did not have a fracture. No child with a low-risk clinical examination had a subsequent high-risk diagnosis (eg, relevant intra-articular fracture, dislocation). Among 64 clinical high-risk diagnoses only 12 significant fractures were found.
Conclusion:
Treatment decisions after PIP hyperextension injuries can be based on a clinical examination using a standardized evaluation protocol. Application of the clinical decision guide presented here has a sensitivity of 100% to rule out a significant injury. Present results showed that the majority of radiographs currently performed are avoidable. Once the decision rule is validated, its clinical application will improve patient care, reduce waiting times in emergency departments, avoid unnecessary radiation exposure, and possibly reduce costs.
