Les fractures, luxations et entorses digitales chez l’enfant

Abstract

The hand is the most commonly injured location of a child. Fractures of the digits are the most frequent lesions with two specific locations: 1) in the young child, the fracture is usually a crush injury, such as occurs when a hand gets caught in a door, with lesion of the distal phalanx; soft tissue associated injuries are the main problem in this location; 2) in the older child, the fracture is usually secondary to recreational sports, with lesion on the proximal phalanx of the second and fifth digits. Dislocations or sprains are less common. Most interphalangeal joint injuries occur at the proximal interphalangeal joint and are secondary to hyperextension with as results a volar plate injury. Most fingers injuries in children are treated non operatively with a favorable outcome. The treating physician should however identify those clinical situations that require surgery, as complications are most commonly due to a failure to identify and treat an injury requiring an operation acutely. These injuries include intra-articular fractures, displaced phalangeal neck fractures, and malrotated fractures. Malrotation or intra-articular malunion have no remodeling capacity. Non-union and stiff digits are uncommon but a significant trauma or a high-energy mechanism with severe soft tissues injuries appears to be a factor of risk.