Dislocation Of The Epiphysis Of The Distal Phalanx: A Case Report And Treatment With S-Quatro

Abstract

Epiphyseal dislocation of the terminal phalanx is a rare injury in children. This injury is also called mallet equivalent injury of which there are four types 1. Type A injuries are seen predominantly in young patients and are usually open injuries that may either be S-H type I or II. In type B injuries a true Bony Mallet occurs with a displaced S-H III or IV fracture. Very rarely a type C (epiphysis extrusion from the joint) injury in growing children may be seen. In toddler such injuries may be missed as epiphysis is not ossified. Even rarer is type D fracture that result in separation of the epiphysis and avulsion of the tendon from the bone. The mechanism of such injuries is usually described as hyper-flexion force and may even involve the nail plate injuries (with and without a nail bed laceration)2. Seymour3 described this angular deformity and advocated conservative approach for minimally displaced fractures. Michakinakis and Vourexaki4 described a case of completely displaced epiphysis and treated with open reduction. We describe a case of epiphysis dislocation presenting three weeks after the injury that was managed by external fixation (SQuattro).