Physeal Phalanx Fractures: To Fix or Not To Fix?

Most physeal fractures can be managed with immobilization alone. However, certain fractures may require surgical intervention. Salter-Harris type II proximal phalanx fractures can typically be successfully treated nonsurgically with immobilization, with or without closed reduction. If clinical malrotation and/or greater than 10° of coronal angulation persists, surgical treatment with closed reduction and Kirschner wire fixation is warranted. Seymour fractures require prompt surgical intervention with irrigation and débridement, reduction, and a course of antibiotics to prevent complications. Nondisplaced bony mallet fractures and those that involve one-third or less of the articular surface can undergo immobilization with the distal interphalangeal joint in full extension if the patient is compliant. Patients who may struggle with compliance, those in whom initial nonsurgical treatment failed, a fracture with more than one-third of articular involvement, and/or subluxation of the distal interphalangeal joint warrant surgical intervention via extension block pinning.