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Pediatric Phalangeal Fracture

 
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Pediatric Phalangeal Fracture ICD-9

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Pediatric Phalangeal Fracture Etiology / Epidemiology / Natural History

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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

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Pediatric Phalangeal Fracture Complications

  • Nonuion
  • 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
  • Infection

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