Phalangeal and Metacarpal Fractures in Children: A 10-Year Comparison of Factors Affecting Functional Outcomes in 313
Ailbhe L Kiely1, Michelle Griffin2, Faith Hyun Kyung Jeon2
1Department of Plastic & Reconstructive Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, United Kingdom.
Insights
Pediatric hand fractures, especially those in the thumb or requiring surgery, need careful monitoring for optimal functional recovery. Early intervention and close follow-up are key for good outcomes in children's hand fractures.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Hand Surgery
Background:
- Pediatric fractures are generally believed to have excellent outcomes due to bone remodeling capacity.
- However, specific fractures, particularly in the hand, require careful management to prevent long-term functional deficits.
- Functional outcomes of pediatric hand fractures remain understudied.
Purpose of the Study:
- To evaluate functional outcomes of operative treatment for pediatric metacarpal and phalangeal fractures.
- To identify fracture characteristics and treatment methods associated with functional impairment.
Main Methods:
- Retrospective cohort study of 313 children and adolescents undergoing operative treatment for metacarpal and phalangeal fractures (2008-2018).
- Exclusion of tuft fractures and replantations.
- Functional outcomes assessed using total active motion (TAM) scoring; good outcome defined as TAM > 75%.
Main Results:
- Proximal phalangeal fractures treated with manipulation under anesthesia showed better outcomes than those with Kirschner-wire or open reduction internal fixation (p=0.043).
- Middle phalanx fractures and metacarpal fractures demonstrated excellent outcomes irrespective of fixation method (p=0.81 and p=0.134, respectively).
- Thumb fractures had poorer postoperative function compared to long finger fractures (p<0.0001), with trends toward worse outcomes in distal phalanx, pediatric Bennett, Seymour, and oblique fractures.
Conclusions:
- Pediatric thumb fractures and phalangeal fractures requiring percutaneous or open fixation warrant closer early postoperative monitoring.
- Optimizing functional potential in these pediatric hand fractures necessitates vigilant follow-up.
- This study highlights specific pediatric hand fracture patterns that may benefit from enhanced management strategies.
Abstract:
Introduction It is widely believed that fractures in children have excellent clinical outcomes due to their capacity to remodel. There are, however, certain fractures that require careful management to avoid long-lasting functional impairment. Functional outcomes following hand fractures in children are poorly studied. Materials and Methods We performed a retrospective cohort study of consecutive children and adolescents who had operative treatment for metacarpal and phalangeal fractures (2008-2018). Tuft fractures and replantations were excluded. Functional outcomes were measured by total active motion (TAM) scoring, where a "good" outcome = TAM > 75%. Fractures were categorized by location, classification, and by the fixation they required. Results Three hundred thirteen children were included. For proximal phalangeal fractures, those treated by manipulation under anesthesia, had a higher proportion of "good" functional outcomes than Kirschner-wire or open reduction internal fixation at discharge from hand therapy ( p = 0.043). Middle phalanx fractures had excellent functional outcomes, with no difference between fixation methods ( p = 0.81). For metacarpals, there was no statistically significant difference in functional outcomes across all managements ( p = 0.134). Fractures in the thumb had poorer postoperative function at mean 7.26 weeks than those in the long fingers ( p < 0.0001), and the data suggested a trend toward worse outcomes in the distal phalanx, pediatric Bennett fractures, Seymour fractures, and oblique fractures. Conclusions Fractures in the thumb and phalangeal fractures that require percutaneous or open fixation may need closer early postoperative monitoring in children to optimize their potential for good function.
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