Rapid Fire New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Surprises in management of paediatric phalangeal fractures (416)

Heather Greig 1 , Loree K 1
  1. Plastics NZ, Lower Hutt, WELLINGTON, New Zealand

Aim: 

To assess the incidence and outcomes of paediatric phalangeal fractures in a tertiary plastic surgical centre.

 

Hypothesis:

The majority of paediatric phalangeal fractures can be managed nonoperatively.

Complications including loss of position requiring further treatment are rare.

  

Introduction:

Phalangeal fractures are relatively common, making up around 50% of all hand fractures1. In paediatrics, the most commonly affected site is the proximal phalanx2. The majority can be managed conservatively, and it can be challenging to determine which patients would benefit by surgery. Degree of displacement, can be useful in guiding management with reduction and k-wire fixation useful for more severe initial displacement2. Phalangeal neck fractures are inherently less stable, and surgical fixation is often required. Complications include limited range of movement, premature closure of physes and malposition3.

 

Methods:

A six year retrospective review was performed of all patients below 18 years seen at Hutt Valley DHB Emergency Department with phalangeal fractures. Data collected included demographics, mechanism of injury, treatment, and follow up. Exclusion criteria were open injuries with soft tissue damage requiring repair, adults, and isolated nailbed injuries.

 

Results:

659 patients were treated for closed phalangeal fractures. 48 (7%) required manipulation under general anaesthetic, and the remainder were managed conservatively with buddy taping and splint with or without manipulation under sedation. Of those requiring general anaesthetic for manipulation, 15% required internal fixation. Complications were rare: two patients presenting in a delayed fashion had malunions, and 3 fractures lost position including one after internal fixation.

  1. 1. Feehan LM, Sheps SB. Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study. J Hand Surg Am. Elsevier; 2006 Sep;31(7):1068–74.
  2. 2. AL-QATTAN MM, AL-ZAHRANI K, AL-BOUKAI AA. The relative incidence of fractures at the base of the proximal phalanx of the fingers in children. Journal of Hand Surgery (European Volume). SAGE Publications; 2008 Aug;33(4):465–8.
  3. 3. Huelsemann W, Singer G, Mann M, Winkler F, Habenicht R. Analysis of Sequelae after Pediatric Phalangeal Fractures. European Journal of Pediatric Surgery. Georg Thieme Verlag KG; 2015 Feb 16;(EFirst).