Phalangeal fractures - paediatric

Proximal phalanx fractures

Most common injury is the SH II fracture of the base of the proximal phalanx. In the little finger, such fractures are known as extra octave fractures and can be reduced with counter force applied to base of finger in the fourth web space. Buddy tape is applied if reduced and stable.

Distal periarticular fractures or "neck" fractures may be missed in young children secondary to the purely cartilaginous distal fracture fragment. The injury most frequently results when a child's finger is closed in a car door or window and forcibly extracted. Because the distal cap may be radiolucent, normal anterior-posterior radiographs in children with this history should be viewed with caution secondary to the need for operative treatment in many of these injuries. True lateral radiographs with isolation views of the affected digit can be helpful. In general, operative treatment is reserved for articular and displaced, unstable injuries.

Middle phalanx fractures

Middle phalanx fractures have characteristics similar to those of proximal phalanx fractures. Articular fractures are usually nondisplaced SH II or III
base fractures that can be treated with buddy taping. Displaced fractures should be treated with fixation.

Distal phalanx fractures

Crush injuries of the distal phalanx are common injuries with a broad spectrum of severity and outcome. Crush injuries may damage the nail bed. Treatment of these injuries has traditionally been nail bed repair. However, Roser and Gellman compared repair with trephination and did not find a significant difference in outcome. Consider prophylactic antibiotics for 3 to 5 days viz open nature of the fracture and the risk of osteomyelitis.

The other injury pattern of the distal phalanx is a physeal injury related to the different sites of insertion of the flexor and extensor tendons on the distal phalanx. The injury may occur during resisted extension of the DIP, resulting in a fracture through the growth plate. Functionally, these fractures are similar to the subluxated mallet fracture in the adult. These fractures have a high rate of complication and should be irrigated, reduced, and held in place with fixation or splinting at the discretion of the surgeon. Treatment with K-wires may have a higher risk of infection.

References

Common pediatric hand fractures; C Nofsinger: Curr Opin Pediatr, Volume 14(1).February 2002.42-45

Richards, Adrian M. F.R.C.S.. Crick, Alexandra M.B.B.S.. Cole, Richard P. F.R.C.S.(Plast.). A Novel Method of Securing the Nail following Nail Bed Repair. Plastic & Reconstructive Surgery. 103(7):1983-1985, June 1999.

Last updated 11/09/15