title: The diaphysial axis-metacarpal head angle in the management of fractures of the base of the proximal phalanx in children.
abstract: The diaphysial axis-metacarpal head angle (DHA) is the angle formed between the longitudinal axis of the diaphysis of the proximal phalanx and central point of the metacarpal head. The normal DHA ranges from 177.1° and 180.0°. There were no significant differences between DHA measurements when taken by the same observer at two separate occasions (P = 0.986) or when taken by two different observers (P = 0.948). We have put an algorithm of management of paediatric phalangeal base fractures incorporating the DHA in the decision making. A prospective study of 92 children (5-14 years) with phalangeal base fractures was conducted. Closed reduction was possible in all but one case in which open reduction and K-wire fixation was required. Closed reduction of the remaining 91 fractures yielded a 'good' reduction in 80 cases (no finger deformity on clinical examination with a post-reduction DHA greater than 177°). After a mean follow-up of 4.2 months, all these 80 cases qualified for an excellent outcome as per Al-Qattan's criteria. The remaining 11 children were considered to have an 'acceptable' reduction (no scissoring, but there was a mild residual lateral deviation of the finger with a DHA angle of 169.4° to 176.2°). At a mean follow-up of 28 months, all these 11 mal-united fractures remodelled with normalization of the DHA; and all 11 children qualified for an excellent outcome as per Al-Qattan's criteria. The current series stresses on the advantages of using DHA in the objective assessment of paediatric phalangeal base fractures and demonstrates the remodelling of fractures with about 10° of lateral deviation.
authors: Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia.
authors: M M
authors: MM
authors: Al-Qattan
authors: M I
authors: MI
authors: Al-Motairi
authors: H A
authors: HA
authors: Al-Naeem
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018483:Diaphyses / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D005260:Female; D050278:Finger Phalanges / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D050279:Metacarpal Bones / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D015588:Observer Variation; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D013165:Splints; D053832:Surgical Tape
keywords: Proximal phalanx; children; fracture