Functional treatment of physeal and periphyseal injuries of the metacarpal and proximal phalangeal bones.
OBJECTIVE
Hand fractures are common injuries in infants. Complications are rare because of potent remodeling dimension and rapid healing of growing bone. There is limited remodeling capacity for angular and rotational deformity so displaced fractures often require open reduction and internal fixation.


METHODS
The authors present a splint system for a protected reduction and mobilization program of displaced proximal phalanx and metacarpal fractures. The custom-molded 2-component thermoplastic splint allows motion of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. It has been developed to allow bone healing and recovery of motion at the same time. In this study, the authors evaluated the clinical and radiologic results of a series of 11 consecutive infants with displaced metacarpal fractures and 13 displaced proximal phalanx fractures who received functional treatment.


RESULTS
Fracture consolidation and full active motion was achieved simultaneously in 4 weeks in 21 children; 2 infants required physiotherapy, and 1 child was lost to follow-up. No further growth abnormality was seen within a 12-month observation period.


CONCLUSIONS
When there is no damage of soft tissue the functional mobilization program can lead to good results treating displaced physeal and periphyseal hand injuries of proximal phalanx and metacarpal fractures. J Pediatr Surg 36:611-615.
Department of Trauma, Hand and Reconstructive Surgery, Ulm University Hospital, Steinhoevelstrasse 9, 89070 Ulm, Germany.
T
T
Ebinger
M
M
Roesch
N
N
Wachter
L
L
Kinzl
M
M
Mentzel
D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D006230:Hand Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007103:Immobilization; D007223:Infant; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013165:Splints