Phalangeal Neck Fractures In Children Research Articles

Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture.

To compare outcomes of type II phalangeal neck fractures in children who received closed reduction followed by splinting immobilization or by K-wire fixation. Furthermore, we analyzed the remodeling potential of residual deformities and the relationship between age and outcomes. Patients in Children's Hospital of Fudan University, Xiamen Hospital were included in the study from October 2015 to October 2018. We compared outcomes between the conservation group and operation group. Remodeling of residual deformities was calculated on a series of anteroposterior and lateral radiography. The correlation between age and outcomes was analyzed using Spearman's rank correlation coefficient. Forty patients (25 males) were enrolled. Nineteen patients had subtype IIa, 19 subtype IIb, and two subtype IIc fractures. Left hands were affected more than right hands, and small finger and proximal phalanx were more frequently involved. There were no significant differences between conservation group and operation group among excellent, good, and fair outcomes. And the outcomes were not significantly different between the IIa and IIb subtypes. An average sagittal remodeling rate was 88.5%, and coronal remodeling rate was 56.71%, respectively, in 13 patients with residual deformities. There was a significant correlation between age and final outcomes. Closed reduction and stable splint fixation may be an effective and economical initial treatment option. Fracture subtype does not seem to be a key factor for choosing treatment options. The fractured phalangeal neck had remodeling potential whether on sagittal or coronal plane. Younger age might be a predictor of better outcomes in children with type II phalanx neck fractures.

Clinical outcomes of closed, displaced phalangeal neck fractures in children with different types of kirschner wire fixation: A retrospective observational study.

Inappropriate treatment of Closed displaced phalangeal neck fractures (CDPNF) in children usually leads to poor outcomes.This study was to evaluate the clinical outcomes of closed/open reduction, age, and different types of fracture and Kirschner wire (K-wire) fixation in the treatment of CDPNF. Participants: Sixty patients (male, 46 and female,14; right-handed, 35 and left-handed, 25; mean age, 7.9-years-old [range, 1.0-14.5 years]) who had CDPNF were included. Preoperative x-rays showed that the fractures were displaced and exhibited obvious deformities. Interventions: First, reduction (four cases of open reduction and 56 cases of closed reduction) was performed followed by percutaneous K-wire fixation (cross fixation, 24 cases; longitudinal and slanting fixation, 17 cases; homolateral fixation, four cases; and single longitudinal fixation, 15 cases,) and immobilized by cast. x-ray examination following removal of the K-wires showed that the fractures were healed; the criteria for fracture healing were callus formation and the absence of fracture lines. Clinical outcome and radiographs between groups were compared. According to the visual analogue scale, the pain scores were excellent. According to the Al-Qattan Grade system(AGS),all the patients presented with closed, type II phalangeal neck fractures,the results were excellent in 36 cases (36/60, 60%), good in 15 cases (15/60, 25%), fair in 5 cases (5/60, 8.3%) and poor in 4 cases (4/60, 6.7%). There were significant differences in different fracture type groups (P = 0.013*), operation age groups (P = 0.025*) and open/closed reduction groups (P = 0.042*). There was no significant difference in K-wire fixation type groups (P > 0.05). Patients with open reduction, the more serious fracture type, the older at the operation, were more likely to have poor AGS result. Different K-wire fixation types for CDPNF in children had the same satisfactory results.

Type II D Phalangeal Neck Fractures in Children: A Series of 20 Cases Treated According to a Preset Stepwise Algorithm

Introduction Type II phalangeal neck fractures are defined as displaced fractures with bone-to-bone contact at the fracture site. In the type II D subtype, the distal fracture fragment is thin. A review of the literature did not reveal any study investigating the outcome of management of these fractures.Patients and Methods This is a retrospective study of 20 consecutive children with type II D phalangeal neck fractures treated over the past 4 years. Demographic data were reviewed. All cases were managed according to the preset stepwise algorithm. The outcome of management at final follow-up was documented using Al-Qattan’s grading system.Results The mean age was 30 months (range 12–80 months). There were 12 males and 8 females. The mean follow-up was 2 years (range 7 months to 3 years). The largest two categories within the management algorithm were patients with minimally displaced fractures treated conservatively (n = 8) and those with displaced fractures treated with closed reduction and percutaneous K-wire fixation (n = 9). Fischer exact test was used to compare the outcome in these two groups and the p value was significant (p = 0.015), indicating a significantly better outcome in the former group.Conclusion Several conclusions were made from the study. Type II D of phalangeal neck fractures tend to occur in young children and the majority involve the middle phalanx. The thinness of the distal fracture fragment makes standard techniques of closed reduction more difficult. However, flexion of the proximal and distal joints appears to be effective in reducing dorsally displaced type II D fractures by closed means. Finally, a more conservative approach to minimally displaced type II D fractures results in a better outcome compared with closed reduction and percutaneous K-wire fixation.

Closed percutaneous reduction by leverage and Kirschner wire fixation for treatment of irreducible phalangeal neck fractures in children

Objective To investigate the clinical efficacy of closed percutaneous reduction by leverage and Kirschner wire fixation in the treatment of irreducible phalangeal neck fractures in children. Methods From January 2016 to March 2019, 12 children with irreducible phalangeal neck fractures ware treated. The time from injury to operation was 1 to 46 days, including 5 cases of old fracture. Closed Kirschner wire puncture was used to clear callus and closed percutaneous reduction by leverage and Kirschner wire fixation were performed. The fracture healing time of the children was followed up after operation. Total active motion (TAM) system was used to evaluate the recovery of finger function. Results All the operations were completed successfully, and no infection, skin necrosis and fracture malunion occurred. All the children were follow-up for 6 to 36 months, with an average of 15.3 months. The fracture healing time was (4.2±0.2) weeks. The Kirschner wire was removed and functional exercises were performed 4 weeks after operation. The finger joint function was evaluated as excellent according to TAM system. Conclusion Closed percutaneous reduction by leverage and Kirschner wire fixation in the treatment of irreducible phalangeal neck fractures in children has the advantages of simple operation, less trauma and definite curative effect. It is necessary to strictly grasp the operative indications for old fracture. Key words: Finger phalanges; Fractures,bone; Fracture fixation; Kirschner wire

Percutaneous Reduction and Fixation of Displaced Phalangeal Neck Fractures in Children

Several methods have been reported for fixation of displaced phalangeal neck fractures in children. The purpose of this study is to present a technique for the closed reduction and percutaneous fixation of displaced phalangeal neck fractures and the clinical results of 4 patients treated by this method. Four consecutive patients with displaced phalangeal neck fractures were treated with closed reduction and single intramedullary Kirschner wire placed percutaneously with a novel technique. The average age at injury was 5 years 9 months (range, 23 mo to 10 y). Three patients were male and 1 was female. Two patients had fractures of the proximal phalangeal neck, whereas the other 2 had fractures of the middle phalangeal neck. After an average follow-up of 18 weeks, all patients had nearly full pain-free flexion and extension of the affected digit. The described technique is a simple, reproducible and effective treatment for displaced phalangeal neck fractures in children. Level IV. Therapeutic study, case series.

Nonunion and Avascular Necrosis Following Phalangeal Neck Fractures in Children

To investigate the characteristics of nonunion and avascular necrosis following phalangeal neck fracture in children. A cohort of all pediatric phalangeal neck fractures complicated by nonunion, with or without avascular necrosis of the phalangeal head, over the last 10 years was reviewed retrospectively. The following data were documented: age, gender, fracture site, mechanism of injury, fracture type, presence of digital ischemia, initial management, and outcome. Our database of phalangeal neck fractures in children over the last 10 years included 215 fractured digits. Of these, 4 developed nonunion (group A) and 8 developed nonunion with avascular necrosis (group B). All patients in group A were young children (mean age, 2.5 y) with fractured thumbs, initially managed by closed reduction and splinting. The fractures redisplaced and failed to unite, resulting in instability that was later treated by bone grafting and stabilization with a K-wire. Patients in group B were older children (mean age, 5.6 y) and 7 of 8 had finger fractures. All 8 patients presented with stiffness of the affected joint, and no further surgery was performed. When nonunion occurs following pediatric phalangeal neck fractures, it usually affects the thumb and presents with thumb instability, and bone grafting is often required to achieve union. In contrast, avascular necrosis following phalangeal neck fractures usually affects the little finger and presents with stiffness, and hence, further surgery is not often required short term, although the long-term result after skeletal maturity is unknown. Therapeutic IV.

Percutaneous reduction of incipient malunion of phalangeal neck fractures in children

Purpose In this article we describe our treatment of partially healed malaligned fractures of the phalangeal neck in children. Methods This was a retrospective study of 8 pediatric patients with phalangeal neck fractures who presented late for care to Children’s Hospital in Boston. All patients were diagnosed clinically and radiographically with advanced partial healing of their fracture in a malunited position of extension. The 8 patients were followed up until fracture healing and restoration of normal motion and function were achieved. Results A K-wire was inserted into the fracture site through the dorsal callus and used to mobilize the fracture fragment by breaking down the fracture callus and partially healed bone. The wire then was used as a lever arm for fracture reduction. A separate wire was used to pin the fracture percutaneously. Conclusions This treatment corrects the loss of flexion that occurs with a malunion in the phalangeal subcondylar fossa. It is a minimally invasive procedure that avoids the soft-tissue dissection of an open procedure.

Remodelling in a malunited phalangeal neck fracture

Several authors have noted the lack of significant remodelling of malunited phalangeal neck fractures in children. This has been explained by the fact that there is no epiphysis at the distal end of the phalanx where the fracture occurs. We reviewed the literature and could only find a single case report of complete remodelling of a malunited phalangeal neck fracture in a 7 year old. We report a second case with such a remodelling.