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Simultaneous juxta-epiphyseal proximal phalanx fracture with flexor tendon entrapment in a child: a case report and review of literature

Rodríguez-Vega, Víctor; Pretell-Mazzini, Juan; Marti-Ciruelos, Rafael; Jorge-Mora, Alberto; de la Mano, Ángel Curto

Journal of Pediatric Orthopaedics B: March 2013 - Volume 22 - Issue 2 - p 148–152
doi: 10.1097/BPB.0b013e3283548596
Upper Limb

Juxta-epiphyseal/Salter–Harris fractures are the most common hand fractures in children and the proximal phalanx is involved in most cases. In the absence of soft-tissue interposition, these growth plate injuries are simple to reduce and are stable. However, in some cases, flexor tendon entrapment could be present. We report on an 11-year-old girl who sustained a fall onto her outstretched hand with subsequent injuries in her long, ring, and small fingers. Plain radiographs showed a severely displaced juxta-epiphyseal proximal phalanx fracture in her ring finger associated with mildly displaced juxta-epiphyseal proximal phalanx fractures of the long and small fingers. Fracture reduction could not be achieved after a closed reduction attempt. An open reduction and stabilization using Kirschner wires was performed in the fourth and fifth fingers, because of entrapment of the flexor digitorum profundus tendon. Excellent functional as well as radiological outcomes were achieved. These types of injuries are very uncommon and a high index of suspicion on the basis of clinical as well as radiological findings is needed to make an early diagnosis and for adequate treatment. Multiple proximal phalangeal fractures could be associated with the simultaneous entrapment of flexor tendons in different fingers as in our case; this is important to keep in mind as it is useful when planning the definitive surgical treatment and doing so will have a positive impact on the final functional as well as radiological outcomes.

Department of Orthopaedics and Traumatology, Pediatric Orthopaedic Division, Doce de Octubre Hospital, Madrid, Spain

Correspondence to Juan Pretell-Mazzini, MD, Pediatric Orthopaedic Attending, Pediatric Orthopaedic Division, Doce de Octubre Hospital, Avda. de Córdoba s/n, Madrid 28041, Spain Tel: +34 670 426 915; fax: +34 913 908 226; e-mail: el_giova23@yahoo.com

© 2013 Lippincott Williams & Wilkins, Inc.