Abstract
The hand is the major medium that children utilize to experience their surrounding world, making it particularly vulnerable to injury. Historically, the incidence of pediatric hand injuries followed a bimodal age distribution during the toddler/preschool years and another spike during adolescence. However, this trend may very well be changing with increased participation in youth athletics. A firm knowledge of pediatric hand pathoanatomy and the intricacies of fracture healing in the child are necessary in order to properly evaluate, diagnose, and treat these injuries. The exuberance of pediatric fracture healing and the potential for remodeling make nonoperative management the mainstay of treatment for most pediatric phalanx fractures. However, rapid fracture healing also results in a narrowed window for treatment. Therefore, the physician must identify those fractures that require special scrutiny and a low threshold for operative intervention. This chapter seeks to provide hand surgeons with a detailed overview of the epidemiology, pathoanatomy, evaluation, and treatment of specific phalanx fractures in the pediatric population. There is an emphasis on fracture subtypes that can become particularly problematic if the diagnosis is missed or initiation of treatment is delayed. These include Seymour fractures, condylar fractures and other intra-articular fractures, phalangeal neck fractures, and fractures with resultant malrotation. Although beyond the scope of this chapter, the evaluation and treatment of associated soft tissue injury deserve equal attention.
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References
Al-Qattan MM. Extra-articular transverse fractures of the base of the distal phalanx (Seymour’s fracture) in children and adults. J Hand Srug Br. 2001a;26:201–6.
Al-Qattan MM. Phalangeal neck fractures in children: classification and outcome in 66 cases. J Hand Surg Br. 2001b;26:112–21.
Al-Qattan MM. Nonunion and avascular necrosis following phalangeal neck fractures in children. J Hand Surg. 2010;35A:1269–74.
Barton NJ. Fractures of the phalanges of the hand in children. Hand. 1979;11:134–43.
Bucholz RW, Heckman JD, Court-Brown C, et al. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.
Chew EM. Hand fractures in children: epidemiology and misdiagnosis in a tertiary referral hospital. J Hand Surg. 2012;37A:1684–8.
Cornwall R. Pediatric finger fractures: which ones turn ugly? J Pediatr Orthop. 2012;32:S25–31.
Cornwall R, Ricchetti E. Pediatric phalanx fractures: unique challenges and pitfalls. Clin Orthop Relat Res. 2006;445:146–56.
Cornwall R, Waters PM. Remodeling of phalangeal neck fracture malunions in children: case report. J Hand Surg. 2004;29A:458–61.
Cowen NJ, Kranik AD. An irreducible juxta-epiphyseal fracture of the Proximal Phalanx: report of a case. Clin Orthop Relat Res. 1975;110:42–4.
Crick JC, et al. Fractures about the interphalangeal joints in children. J Orthop Trauma. 1988;1:318–25.
Day CS, Stern PJ. Fractures of the metacarpals and phalanges. In: Wolfe SW, Hotchkiss RN, Penderson WC, Kozin SH, editors. Green’s operative hand surgery, vol 1. 6th ed. Philadelphia: Elsevier/Churchill Livingstone; 2011. p. 239–90.
Egol KA, et al. Pediatric wrist and hand. Handbook of fractures. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2010. p. 660–80.
Engber WD, Clancy WG. Traumatic avulsion of the finger nail associated with injury to the phalangeal epiphyseal plate. J Bone Joint Surg. 1978;60:713–4.
Ganayem M, Edelson G. Base of distal phalanx fracture in children: a mallet finger mimic. J Pediatr Orthop. 2005;25:487–9.
Grad JB. Children’s skeletal injuries. Orthop Clin North Am. 1986;17:437–49.
Graham TJ, Hastings H. Chapter 70: Fractures and dislocations in the child’s hand. In: Gupta A, editor. The growing hand: diagnosis and management of the upper extremity in children. Barcelona: Harcourt Publishers; 2000. p. 583–607.
Hastings II H, Simmons BP. Hand fractures in children. A statistical analysis. Clin Orthop Relat Res. 1984;188:120–30.
Karl J, et al. Percutaneous reduction and fixation of displaced phalangeal neck fractures in children. J Pediatr Orthop. 2012;32:156–61.
Katarincic JA, et al. Pediatric upper extremity. In: Elzouki AY et al., editors. Textbook of clinical pediatrics. Berlin: Springer; 2011.
Kozin SH, Waters PM. Fractures and dislocations of the hand and carpus in children. In: Beaty J, Kasser J, editors. Rockwood and Wilkins fractures in children. Philadelphia: Lippincott and Wilkins; 2006. p. 257–333.
Krusche-Mandl I, et al. Seymour fractures: retrospective analysis and therapeutic considerations. J Hand Surg. 2013;38A:258–64.
Mahabir RC, Kazemi AR, Cannon WG, Courtemanche DJ. Pediatric hand fractures: a review. Pediatr Emerg Care. 2001;17:153–6.
Nogueira A, et al. Irreducible phalangeal fracture in a child due to flexor tendon entrapment. J Hand Surg. 1999;24A:924–7.
O’Brien ET. Fractures of the hand and wrist region. In: Rockwood CA, Wilkins KE, King RE, editors. Fractures in children. Philadelphia: JB Lippincott; 1984. p. 229–99.
Paksima N, et al. Percutaneous pinning of middle phalangeal neck fractures: surgical technique. J Hand Surg. 2012;37A:1913–6.
Puckett BN, et al. Remodeling potential of phalangeal distal condylar malunions in children. J Hand Surg. 2012;37A:34–41.
Rajesh A, Basu AK, Vaidhyanath R, Finlay D. Hand fractures: a study of their site and type in childhood. Clin Radiol. 2001;56:667–9.
Rang M, Pring ME, Wenger DR. Chapter 11: Hand Reng’s children’s fractures. Philadelphia: Lippincott Williams & Wilkins; 2005.
Rodriguez-Vega V, et al. Simultaneous juxta-epiphyseal proximal phalanx fracture with flexor tendon entrapment in a child: a case report and review of literature. J Pediatr Orthop B. 2013;22(2):148–52.
Segmuller G, Schonenberger F. Treatment of fractures in children and adolescents. In: Weber BG, Brunner C, Freuler F, editors. Fracture of the hand. New York: Springer; 1980. p. 218–25.
Seymour N. Juxta-epiphyseal fracture of the terminal phalanx of the finger. J Bone Joint Surg. 1966;48:347–9.
Simmons BP, Peters TT. Phalangeal neck fractures in children: classification and outcome in 66 cases. J Hand Surg Am. 1987;12:1079–82.
Shewring DJ, Miller AC, Ghandour A. Condylar fractures of the proximal and middle phalanges. J Hand Surg Eur. 2013.
Torre BA. Epiphyseal injuries in the small joints of the hand. Hand Clin. 1988;4(1):113–20.
Vadivelu R, et al. Hand injuries in children: a prospective study. J Pediatr Orthop. 2006;26(1):29–35.
Waters PM. Problematic pediatric wrist and hand injuries. J Pedatr Orthop. 2010;30:S90–5.
Webbe MA, Scheides LH. Mallet fractures. J Bone Joint Surg Am. 1984;66:658–69.
Weiss AP, Hastings H II. Distal unicondylar fractures of the proximal phalanx. J Hand Surg Am. 1993;18(4):594–9.
Worlock P, Stower MJ. The incidence and pattern of hand fractures in children. J Hand Surg Br. 1986;11:198–200.
Yeh PC, Dodds SD. Pediatric hand fractures. Tech Orthop. 2009;24(3):150–62.
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Feller, R., Kluk, A., Katarincic, J. (2015). Pediatric Phalanx Fractures: Evaluation and Management. In: Abzug, J., Kozin, S., Zlotolow, D. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8515-5_44
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DOI: https://doi.org/10.1007/978-1-4614-8515-5_44
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