Outcomes of a Mini External Fixator System for the Treatment of Unstable Periphyseal Hand Fractures
Silvia Germano1, Enrico Cavalieri1,2, Luca Patanè2
1Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy.
Insights
The mini external fixator system (MEFS) effectively treats unstable pediatric hand fractures, offering a safe alternative to Kirschner wires and preventing physeal injury. This method ensures fracture union and full range of motion recovery.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Traumatology
Background:
- Unstable pediatric hand fractures often require osteosynthesis when closed reduction fails.
- Kirschner (K)-wires are a common fixation method but risk iatrogenic physeal injury.
- The mini external fixator system (MEFS) presents an alternative for periphyseal hand fractures.
Purpose of the Study:
- To describe the application of the MEFS for treating unstable periphyseal hand fractures in children.
- To report the clinical outcomes and efficacy of MEFS in this patient population.
Main Methods:
- Retrospective review of pediatric patients treated with MEFS for periphyseal hand fractures (March 2010 - December 2019).
- Data collected included demographics, injury details, fracture classifications (Salter-Harris, Al-Qattan), and radiographic outcomes.
- Functional outcomes assessed included range of motion and residual deformity at 3 months postoperatively.
Main Results:
- Fourteen unstable periphyseal hand fractures were treated with closed reduction and MEFS.
- All fractures achieved union, and patients regained full range of motion without significant residual deformity.
- No cases of pin site infection or loosening occurred; the device was well-tolerated.
Conclusions:
- MEFS is a viable and effective treatment option for unstable pediatric periphyseal hand fractures.
- This method provides good functional outcomes while mitigating the risk of physeal damage associated with K-wires.
Abstract:
Background: Most unstable hand fractures in children are treated by closed methods. If osteosynthesis is required, Kirschner (K)-wires are commonly used, though they carry a risk of injury to the physis. We have been using a mini external fixator system (MEFS) for the treatment of unstable periphyseal fractures of the hand. The aim of this study is to describe the application and report the outcomes of MEFS for the treatment of periphyseal fractures of the hand. Methods: We retrospectively reviewed all the patients with periphyseal fracture of the hand treated with MEFS from March 2010 to December 2019. Data with regard to age, sex, hand dominance, digit and bone injured, mechanism of injury, medical records and related radiographs were collected. Salter-Harris classification was used to classify epiphyseal fractures and the Al-Qattan classification for categorising neck fractures. Range of motion and residual deformity of the affected fingers were evaluated during follow-up and at 3 months postoperatively. Results: Fourteen periphyseal unstable fractures were treated using closed reduction and MEFS. Only one patient with a fracture of the neck of the proximal phalanx of the little finger required revision surgery. No patient had pin site infection or pin loosening and the device was well tolerated by all patients. All fractures united and all the patients recovered a full range of motion at final follow-up. Conclusions: The MEFS is a reasonable alternative for unstable periphyseal fractures with good outcomes and avoids the risk of iatrogenic physeal injury from K-wire fixation. Level of Evidence: Level IV (Therapeutic).
