title: Analysis of Sequelae after Pediatric Phalangeal Fractures.
abstract: BACKGROUND
  The majority of pediatric phalangeal fractures yield excellent results following conservative or operative treatment. However, a certain subset of fractures is associated with long-term sequelae such as osteonecrosis, physeal growth arrest, malunion, and malposition.
  
  
  METHODS
  This study summarizes all sequelae following phalangeal fractures treated within a 10-year period (2003-2012). The underlying fractures were analyzed and classified in fractures with extensive soft tissue involvement, fractures involving the joint and adjacent bony parts, neck fractures, fractures complicated by infection and sequelae after simple fractures following inadequate initial treatment.
  
  
  RESULTS
  In total, 40 patients (27 males; 13 females) with a mean age of 6.2 years (range, 1-18 years) were treated for sequelae following fractures of the phalanges. Ten patients (6 males; 4 females) developed sequelae (limited range of motion, premature physeal closure) following fractures with extensive soft tissue damage. Thirteen patients presented with sequelae (mostly limited range of motion, premature physeal closure) following fractures involving the joint and adjacent bony parts of the phalanges. Transcondylar and subcondylar neck fractures leading to sequelae were seen in 10 patients. Sequelae consisted of limited range of motion in nine and malposition in six cases. In half of the patients, osteonecrosis (n = 5) and premature physeal closure (n = 5) complicated the clinical course. Three patients with open fractures and four patients with inadequate initial treatment presented with sequelae.
  
  
  CONCLUSIONS
  Most sequelae of phalangeal fractures are consequences of fracture per se and are therefore fateful. However, the degree and severity of the long-term sequelae can be minimized by a correct and timely treatment.
authors: Department of Hand Surgery, Children's Hospital Wilhelmstift, Hamburg, Germany.
authors: Wiebke
authors: W
authors: Huelsemann
authors: Department of Pediatric and Adolescent Surgery, Medical University Graz, Graz, Austria.
authors: Georg
authors: G
authors: Singer
authors: Department of Hand Surgery, Children's Hospital Wilhelmstift, Hamburg, Germany.
authors: Max
authors: M
authors: Mann
authors: Department of Hand Surgery, Children's Hospital Wilhelmstift, Hamburg, Germany.
authors: Frank J
authors: FJ
authors: Winkler
authors: Department of Hand Surgery, Children's Hospital Wilhelmstift, Hamburg, Germany.
authors: Rolf
authors: R
authors: Habenicht
mesh_terms: D000293:Adolescent; D017760:Bone Malalignment / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D050278:Finger Phalanges / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010020:Osteonecrosis / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000150:complications / Q000601:surgery; D013530:Surgical Wound Infection / Q000150:complications