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Outcomes of Pediatric Proximal Phalanx Base Fractures
John Schutz1, Hannah Korrell, Nicole Look
1From the Department of Orthopedics, University of Colorado, School of Medicine, Aurora, CO (Schutz, Korrell, Look, Lalka, and Sibbel), the Department of Orthopedics, Children's Hospital Colorado, Aurora, CO (Lalka, and Sibbel), and the Department of Orthopedics, Children's Mercy Hospital, Kansas City, MO (Hild, Cleary, and Sinclair).
Insights
Extra-articular proximal phalanx fractures in children rarely need surgery. Most cases can be managed non-surgically with or without closed reduction (CR), achieving good outcomes.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma
- Hand Surgery
Background:
- Extra-articular juxtaphyseal fractures of the proximal phalanx are common in children.
- Current standard care involves 3-4 weeks of immobilization post-reduction.
- This study evaluates outcomes and radiographic criteria for managing these fractures.
Purpose of the Study:
- To evaluate outcomes of pediatric proximal phalanx base fractures.
- To establish radiographic criteria for guiding management.
- To assess the efficacy of different treatment interventions.
Main Methods:
- Retrospective review of skeletally immature patients with proximal phalanx juxtaphyseal fractures (2002-2019).
- Collected data included Salter-Harris classification, angulation, displacement, rotational deformity, and treatment method.
- Excluded fractures with <3 weeks follow-up, Salter-Harris III-V, or inadequate records.
Main Results:
- 634 fractures analyzed, categorized into no reduction, closed reduction (CR), and surgical (OP) groups.
- CR and OP groups showed significant angulation reduction (11.8° and 19.0°, respectively).
- Low rotational malalignment rate (0.93%) observed, with similar rates in no reduction and CR groups.
Conclusions:
- Extra-articular proximal phalanx juxtaphyseal fractures seldom require surgery.
- Treatment can be non-surgical with or without CR, guided by deformity degree.
- Nonsurgical management shows low rates of sequelae, enabling treatment parameter establishment.
Introduction:
Extra-articular juxtaphyseal fractures of the proximal phalanx are among the most common finger fractures in children. Immobilization of the digit for 3 to 4 weeks after reduction of the fracture is the current standard of care. The purpose of this retrospective study was to evaluate outcomes after intervention among pediatric proximal phalanx base fractures and establish radiographic criteria to guide management.
Methods:
A multi-institutional retrospective review of skeletally immature patients treated for proximal phalanx juxtaphyseal fractures between 2002 and 2019 was conducted. Variables collected included Salter-Harris classification; initial, postreduction, early follow-up, and final angulation and displacement on the posterior-anterior and lateral radiographs; clinical rotational deformity at final follow-up; and method of treatment. Exclusion criteria included less than 3 weeks of follow-up; Salter-Harris III, IV, and V fractures; inadequate medical record details; and missing radiographs.
Results:
Six hundred thirty-four fractures meeting the inclusion criteria were categorized into no reduction, closed reduction (CR), and surgical (OP) groups. Only CR and OP groups saw large decreases in angulation by 11.8° CR (95% confidence interval, 10.1 to 13.6) and 19.0° OP (95% confidence interval, 8.7 to 29.3). Closed reduction patients had a mean coronal angulation value of 6.1° at post-reduction, which was maintained with immobilization to 5.8° at final follow-up. At final follow-up, scissoring was noted, three in the no reduction and three in the CR group for an overall 0.93% rotational malalignment rate.
Discussion:
Extra-articular proximal phalanx juxtaphyseal fractures rarely require surgical management and can typically be treated with or without CR, based on the degree of deformity, in the emergency department or clinical setting. Low rates of documented sequelae after nonsurgical management were seen in this cohort, allowing for establishment of treatment parameters that can result in clinically insignificant angular and rotational deformity.
Level Of Evidence:
Therapeutic IV.
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