The authors reviewed 37 children presenting with closed, unstable fractures of the proximal phalangeal head. Fractures were classified as intra-articular (n = 15), including 14 unicondylar and 1 bicondylar, or extra-articular (n = 22), including 20 subcondylar and 2 comminuted subcondylar. Eighteen patients underwent closed reduction with K-wire fixation (n = 11) or dynamic skeletal traction (n = 7). Nineteen patients underwent open reduction with K-wire fixation (n = 14) or miniscrews (n = 5). Results were considered excellent when the active range of motion (ROM) of the proximal interphalangeal joint was ≥ 90° (n = 26); fair, active ROM, 70 to 89° (n = 6); and poor, active ROM < 70° (n = 5). The intra-articular fractures were rated 9 excellent, 5 fair, and 1 poor. The extra-articular fractures were rated 17 excellent, 1 fair, and 4 poor. The 18 closed reductions, K-wire fixation (n = 11) and traction (n = 7), were rated 16 excellent and 2 fair. The 19 open reductions, K-wire fixation (n = 14) and miniscrew fixation (n = 5), were rated 10 excellent, 4 fair, and 5 poor. Closed reduction showed better results than open reduction. Dynamic skeletal traction proved to be simple and effective in treating these injuries.
A review of 37 pediatric closed, unstable fractures of the proximal phalangeal head demonstrated excellent results in 77% of extra-articular and 60% of intra-articular fractures. Closed reductions (some with dynamic skeletal traction) showed 89% excellent results, compared with 53% of open reductions.
From the Division of Plastic Surgery, Hôpital Sainte-Justine, Université de Montréal, Canada.
Received May 21, 2004, and accepted for publication, after revision, July 16, 2004.
Presented in part at the 55th annual meeting of the Canadian Society of Plastic Surgeons; Jasper, Canada; June 2001.
Reprints: Louise Caouette-Laberge, MD, 3175 Cote Ste-Catherine O, 7907, Montreal, Canada, H3T 1C5. (Tel): 514-345-4771; (fax): 514-345-4964; E-mail: louise_laberge@SSSS.gouv.qc.ca.