A unique fracture pattern of the proximal phalanx in children: fractures through the phalangeal neck with an attached dorsal bony flange

This paper describes a unique fracture pattern of the proximal phalanx in children that has not been specifically studied in the literature. Volarly, the fracture line passes through the phalangeal neck and then the fracture line passes dorsally to include a dorsal flange of the metaphysis. Fractures were classified into three types: type I fractures were undisplaced with no finger deformity; type II fractures were mildly displaced in the antero-posterior plane without lateral angulation or scissoring; while type III fractures were severely displaced or had associated lateral angulation or scissoring deformity. Over a 6-year-period, nine cases were seen by the authors. The mechanism of injury was by entrapping the digit in a closing door in all cases. The mean age of patients was 5 years. Types I and II fractures were seen in five children and all were treated by splinting with an excellent outcome. Two children with type III fractures were treated with closed reduction and either splinting (one case) or k-wire (one case), and both had a poor initial outcome. The remaining two children with type III fractures were treated with open reduction and internal fixation with an excellent outcome. Differences between these fractures and the classic phalangeal neck fractures are discussed.