Treatment of phalangeal neck fractures in children: technical suggestion

INTRODUCTION: Phalangeal neck fractures in children are not very frequent lesions. The purpose of this study is to bring out results of treatment of these fractures and provide an adequate procedure. PATIENTS AND METHODS: Twenty-three patients with 24 phalangeal neck fractures were reviewed. Seventeen boys and six girls with a mean age of 7 years and 6 months. Open wound fractures were noted in 13 cases. A direct trauma was noted in 17 cases and an indirect trauma in seven cases. Treatment consisted of a closed reduction and cast immobilization in four cases. A closed reduction and percutaneous pinning in seven cases. Open reduction and osteosynthesis in 13 cases. RESULTS: All patients were reviewed with a mean follow-up of 16 months and functional results were evaluated by measuring the Total Active Motion. Fractures treated orthopedically (4) gave Good results; percutaneous pinning (seven cases) gave one Poor, one Fair and five Good results; open reduction and osteosynthesis gave zero Good, six Fair and seven Poor results. Phalangeal head osteonecrosis was noted in four cases treated by open reduction. DISCUSSION: Closed reduction and percutaneous treatment of these fractures give the best functional results. This study demonstrates that open surgical reduction of these fractures leads to phalangeal head osteonecrosis and poor functional result. We propose here a technical improvement of percutaneous reduction with intrafocal pining and osteosynthesis. CONCLUSION: This technical improvement of percutaneous reduction and pinning allow to combine the advantages of a closed reduction and to avoid distal epiphyseal necrosis.