Pediatric proximal phalanx fractures: outcomes and complications after the surgical treatment of displaced fractures

Abstract

Background: The outcomes literature on proximal phalanx fractures in children is sparse. The purpose of this study is to report the complications and outcomes of displaced proximal phalanx fractures after treatment with closed reduction and percutaneous pinning (CRPP).

Methods: A retrospective chart review identified 105 patients treated with CRPP of displaced proximal phalanx fractures. Specific complications were recorded for all patients. Thirty-one of these patients returned >1 year after surgery for assessment including visual analogue scales (VAS) of pain level, functional ability, and esthetics. Objective measurements included range of motion, grip and pinch strength, and finger deformity. Radiographs were taken to assess deformity.

Results: Five of the 105 patients (4.8%) had a complication including infection, pin site complication, or malunion. Of the entire group, 36 had stiffness and 31 ultimately underwent hand therapy to regain motion. Subcondylar fractures were associated with a greater likelihood of stiffness. In the 31 patients returning for assessment, the median VAS score was 0 for pain (none), function (full), and esthetics (perfect). Range of motion, grip, and pinch strength were equivalent to the contralateral side. Seven of the 31 patients (22.6%) had a measureable coronal plane deviation averaging 5 degrees (range, 3 to 13 degrees) on radiographs. Deviation was associated with subcondylar fractures and a worse esthetic VAS. Deviation was not associated with worse outcomes overall.

Conclusions: Pediatric patients with a displaced proximal phalanx fracture treated with CRPP have an initial notable complication rate related to stiffness; subcondylar proximal phalanx fractures are more commonly affected. At >1-year follow-up, patients had full motion, no pain, and were happy with both function and appearance despite minor deformity in some. These complication data may help better inform patients and families before surgical intervention.

Level of evidence: Level IV-therapeutic.

Figure 1

Anteroposterior (1a) and lateral (1b) radiographs of a typical fixation pattern for a proximal phalanx Salter Harris 2 fracture. Antegrade pins are left outside of the skin for removal in clinic at 4 weeks.

Figure 1

Anteroposterior (1a) and lateral (1b) radiographs of a typical fixation pattern for a proximal phalanx Salter Harris 2 fracture. Antegrade pins are left outside of the skin for removal in clinic at 4 weeks.

Figure 2

Anteroposterior (1a) and lateral (1b) radiographs of a typical fixation pattern for a subcondylar fracture of the proximal phalanx. Retrograde pins are left outside of the skin for removal in clinic at 4 weeks.

Figure 2

Anteroposterior (1a) and lateral (1b) radiographs of a typical fixation pattern for a subcondylar fracture of the proximal phalanx. Retrograde pins are left outside of the skin for removal in clinic at 4 weeks.