Pediatric Phalangeal Fracture ICD-9
Pediatric Phalangeal Fracture Etiology / Epidemiology / Natural History
Pediatric Phalangeal Fracture Anatomy
- usually distal fragment displaces into extension. Proximal metaphyseal fragment occludes the volar subchondral fossa and blocks IP flexion.
- Collateral ligaments preserve blood supply to distal fragment. If open reduction is needed, ensure collateral ligaments are preserved. (Yousif NJ, J Hand Surg Am 1985;10:852-861)
Pediatric Phalangeal Fracture Clinical Evaluation
- ensure pt has a normal cascade (no malrotation)
Pediatric Phalangeal Fracture Xray / Diagnositc Tests
- a/p and lateral views of involved finger, NOT a/p and lateral views of the hand
Pediatric Phalangeal Fracture Classification / Treatment
- Non-displaced: buddy tape, consider volar splint initially followed by gentle ROM.
- Displaced: consider CRPP: smooth k-wires placed obliquely from the radial and ulnar condyles from distal to proximal across the fracture site.
Pediatric Phalangeal Fracture Associated Injuries / Differential Diagnosis
Pediatric Phalangeal Fracture Complications
- Malunion,: if radiolucency is still evident, attempt percutaneous pin osteoclasis with CRPP. Avoid central extensor mechanism. Pin may be used to lever fx volarly to restore subchondral fossa. (Bernstein SM, J Pediatr Orthop 1993:13;85-88) If fully healed consider osteotomy (Simmons BP, J Hand Surg Am 1987;12:1079-1082) or remodeling (Hennirkus WL, JBJS Br 2003;85:273-274
Pediatric Phalangeal Fracture Follow-up Care
- immobilization for 4 wks
- pin removal at 3-4 weeks with radiographic evidence of healing.
- aggressive ROM exercises with occupational therapy if needed to restore full ROM
Pediatric Phalangeal Fracture Review References