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Subcondylar Fossa Reconstruction in Pediatric Patients Following Malunion of Proximal Phalangeal Neck Fractures:
David P VanEenenaam1, Sarah L Struble2, Eliza Buttrick1
1Division of Orthopaedics, The Children's Hospital of Philadelphia.
Insights
This study revisits the Simmons subcondylar fossa reconstruction technique for pediatric phalangeal neck fractures. The procedure effectively restored finger flexion in young patients, offering a viable surgical option.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hand surgery
Background:
- The subcondylar fossa is crucial for proximal interphalangeal (PIP) joint flexion.
- Malunion of proximal phalangeal neck fractures can lead to bony blocks in the subcondylar fossa, limiting finger flexion.
- Surgical correction of these malunions is challenging due to the small size of the phalangeal head and risks like avascular necrosis.
Purpose of the Study:
- To describe the subcondylar fossa reconstruction technique for pediatric patients.
- To present the outcomes of this surgical technique in pediatric cases.
- To evaluate the efficacy and safety of the Simmons technique in a pediatric population.
Main Methods:
- The study describes the subcondylar fossa reconstruction technique, involving direct removal of the bony block at the phalangeal neck.
- The technique was applied to 4 pediatric patients with malunion of proximal phalangeal neck fractures.
- Outcomes were assessed based on the restoration of finger flexion and any complications.
Main Results:
- The subcondylar fossa reconstruction technique was successfully applied in 4 pediatric patients.
- The surgical intervention led to restoration of finger flexion in all treated cases.
- No significant complications such as avascular necrosis or joint contracture were reported.
Conclusions:
- The subcondylar fossa reconstruction technique is a simple, safe, and effective method for managing malunited proximal phalangeal neck fractures in pediatric patients.
- This technique offers a valuable surgical option for restoring PIP joint function in children.
- Further studies may explore long-term outcomes and compare this technique with other surgical approaches in pediatric populations.
Abstract:
The subcondylar fossa is the bony depression between the articulating surface of the proximal and middle phalanges of the fingers that allows for full flexion at the proximal interphalangeal joint. A bony block may form in the subcondylar fossa secondary to the malunion of a proximal phalangeal neck fracture. If there is a substantial loss of flexion, surgical correction could be indicated. Corrective osteotomy is technically challenging in the proximal interphalangeal joint area as the phalangeal head is small, creating fixation challenges and carrying the risk of avascular necrosis and joint contracture. Current literature describes multiple techniques with varying complexity and there is no consensus on the ideal operation to manage these fractures after malunion. The subcondylar fossa reconstruction first proposed by Simmons and colleagues is a simple and safe surgical technique that involves directly removing the bony block at the phalangeal neck. Despite its utility, it has not been described in pediatric patients since its original report of 3 patients in 1987. This study describes the subcondylar fossa reconstruction technique and presents the outcomes of its application in 4 pediatric patients.
