A stepwise algorithm for surgical treatment of type II displaced pediatric phalangeal neck fractures.
OBJECTIVE
To evaluate a stepwise reduction algorithm including closed, percutaneous, and open reduction techniques followed by percutaneous pin fixation for displaced pediatric phalangeal neck fractures.


METHODS
Sixty-one consecutive children (mean age, 9.4 y; range, 2-18 y) presenting with closed, type II displaced phalangeal neck fractures were treated using the following algorithm. If satisfactory reduction was achieved with closed reduction, percutaneous pinning (CRPP) was performed. If not achieved, then percutaneous reduction and pinning (PRPP) was performed using a temporary intrafocal joystick for reduction and for osteoclasis as needed. If percutaneous reduction failed, open reduction and percutaneous pinning (ORPP) was performed. Using the Al-Qattan system, radiographic and clinical outcomes were retrospectively graded for union, deformity, range of motion, and function.


RESULTS
Satisfactory alignment was achieved in all 61 fractures, by CRPP in 49 and PRPP in 12. No fracture required open reduction. Mean number of days from injury to surgery was 8 days for CRPP and 17 days for PRPP. All fractures treated after 13 days required percutaneous pinning. Fifty-three patients were followed for at least 1 year or until full functional recovery was achieved, with 45 excellent, 4 good, 1 fair, and 3 poor results. Four complications accounted for the fair and poor results, including 1 flexion contracture, 1 nonunion following pin track infection, and 1 case of avascular necrosis following a severe crush injury in the CRPP group and 1 flexion contracture following PRPP.


CONCLUSIONS
Our stepwise algorithm for surgical treatment of closed, type II displaced pediatric phalangeal neck fractures produced 92% good to excellent results while minimizing the need for open reduction even in late-presenting fractures.


METHODS
Therapeutic IV.
Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Jonas L
JL
Matzon
Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: roger.cornwall@cchmc.org.
Roger
R
Cornwall
D000293:Adolescent; D000465:Algorithms; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D005260:Female; D050278:Finger Phalanges / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005592:Fracture Fixation / Q000295:instrumentation*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
Pediatric; percutaneous fixation; percutaneous reduction; phalangeal neck fractures