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Management of Pediatric Volar Plate Avulsion Fractures of the Proximal Interphalangeal Joint: A Systematic Review
Hongseo Choi1, Seong Hui Moon2, Hosouk Lee3
1College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Insights
Nonsurgical treatment is effective for pediatric proximal interphalangeal joint volar plate avulsion fractures with less than 30% joint involvement. Surgical intervention is recommended for fractures exceeding 30% joint involvement, yielding positive outcomes in both cases.
Area of Science:
- Orthopedic surgery
- Pediatric hand surgery
- Traumatology
Background:
- Volar plate avulsion fractures of the proximal interphalangeal joint are common pediatric hand injuries resulting from hyperextension.
- Improper management can lead to long-term complications like stiffness and flexion contracture.
Purpose of the Study:
- To review the literature on the management and outcomes of pediatric proximal interphalangeal joint volar plate avulsion fractures.
- To compare the efficacy of surgical versus nonsurgical interventions based on fracture characteristics.
Main Methods:
- A systematic literature search was conducted across multiple databases (PubMed, Scopus, Embase, Google Scholar, Cochrane CENTRAL) up to June 15, 2023.
- Twenty-five articles involving 268 pediatric patients (ages 3-17) were included based on predefined criteria.
- Fracture classification (Eaton, Keifhaber-Stern) and percentage of joint involvement guided treatment decisions.
Main Results:
- Nonsurgical management was employed for fractures involving less than 30% of the joint (Eaton I-II, Keifhaber-Stern "Stable").
- Surgical interventions (open reduction and internal fixation) were used for fractures with >30% joint involvement or specific classifications (Eaton IIIa-IIIb, Keifhaber-Stern "Tenuous"/"Unstable").
- Positive outcomes were reported in 99.5% of nonsurgically treated patients and 85.7% of surgically treated patients.
Conclusions:
- Nonsurgical treatment is highly effective for pediatric proximal interphalangeal joint volar plate avulsion fractures with less than 30% joint involvement.
- Surgical intervention demonstrates positive results for fractures with greater than 30% joint involvement.
- Larger prospective studies with standardized measures are recommended to validate these findings.
Background:
Sudden, forced hyperextension injuries to the proximal interphalangeal joint leading to volar plate avulsion fractures are common hand injuries in children. Suboptimal management of these fractures can lead to the development of long-term complications such as stiffness and flexion contracture.
Methods:
MEDLINE (PubMed), Scopus, Embase, Google Scholar, and Cochrane CENTRAL databases were systematically searched, and additional studies were found through reference of articles up to June 15, 2023. Identified articles were assessed using predetermined inclusion/exclusion criteria.
Results:
Twenty-five articles were included, involving 268 patients with ages from 3 to 17 years. Fractures with less than 30% joint involvement, classified as Eaton type I or II, or designated as "Stable" in the Keifhaber-Stern classification, were treated through nonsurgical means. Surgical interventions, encompassing open reduction and internal fixation, were reserved for fractures with more than 30% joint involvement and/or meeting criteria such as Eaton type IIIa or IIIb and Keifhaber-Stern "Tenuous" or "Unstable." Positive outcomes were seen in 99.5% of patients receiving nonsurgical treatment, compared with 85.7% in the surgical cohort.
Conclusions:
The literature demonstrated positive outcomes for fractures presenting with less than 30% joint involvement that were managed nonsurgically. In fractures with more than 30% joint involvement, surgical interventions yielded positive results. To further substantiate these findings, larger prospective studies with uniform measures are needed to validate the results of this study.
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