Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures

Abstract

Iatrogenic comminution of the phalangeal head during management of phalangeal neck fractures has not been previously investigated. To investigate the causes and outcomes of this particular iatrogenic complication. A database of phalangeal neck fractures over a six-year period (2006 to 2011) was reviewed for this iatrogenic complication. Special attention was devoted to documenting the cause and pattern of comminution of the phalangeal head, as well as the outcome in range of motion. Of 152 cases treated during the study period, there were five (two children and three adults) with comminution. Two patterns of comminution were encountered: splitting and fragmentation of the phalangeal head. The complication occurred during open reduction and K-wire fixation, or during closed reduction in the emergency room. The outcome was generally poor and worse in patients with fragmentation of the entire head. Two of the five cases ultimately resulted in medicolegal claims. Comminution of the phalangeal head is a serious iatrogenic complication that may occur during the management of phalangeal neck fractures. Awareness of this complication is important and attempts should be made to avoid it.