Introduction Fractures of the phalanges in children can often be underappreciated by the physician of first contact. Therefore it is necessary to point out which of these fractures, because of the risk of possible future complications, need special mention. Materials and Methods A retrospective review of 512 fractures of the phalanges in children and adolescents during an one year period. Fractures were subdivided into the following categories – physeal fractures, intraarticular (phalangeal neck and condylar) fractures, shaft fractures, tuft fractures, “mallet finger” fractures, volar plate avulsion injuries and collateral ligament avulsion injuries. Main outcome measures was the necessity for operation while the average age at which the injury has occured, the cause of the injury, the frequency of injury of each finger, the necessity for reduction, and the duration of splinting were the secondary outcome measures. Results Collateral ligament avulsion injuries and intraarticular (phalangeal neck and condylar) fractures were injuries which most often necessitated operative treatment. Physeal injuries were the most common injuires with avulsions of the volar plate being the second most common. Accidents during sport was by far the most common cause of injuires in all categories apart from tuft injuries. Conclusion The findings regarding the incidence and the cause of these injuries in this study support the already published dana in the literature. The physician of first contact has to be capable to recognise the problematic fractures – intraarticular (phalangeal neck and condylar), significantly displaced Salter-Harris type III and IV fractures and collateral ligament avulsion injuries and Seymour fractures.

Purpose: Presentation of surgical treatment of a girl with type IV radial longitudinal deficiency and type IV thumb hypoplasia as well as review of the most relevant literature published in the previous 25 years. Methods: The treatment consisted of placement of an external fixator and subsequent distraction in the radioulnar and proximodistal axis as the initial procedure followed by radialization according to Buck-Gramcko around the 2nd birthday, 10 weeks after the primary procedure. The last step of the treatment was a pollicization of the index finger performed before the 4th birthday. Results: The surgical treatment resulted with a very favorable outcome – a clinically stable wrist, radiologically well aligned carpus over the ulna and an index pollicised in such a manner that enables adequate opposition to the other fingers. Conclusion: A review of literature in the last 25 years shows that radialization of the ulna with a preceding distraction offers benefits over centralization alone. Distraction of the wrist protects the distal ulnar growth plate and thus promotes growth. Soft tissue release with a bilobar flap can also provide a good outcome as wells as a microvascular joint transfer from the 2nd toe whereas the latter requires advanced microsurgical skills.

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Prijelomi članaka prstiju šake kod djece patologija su s kojom se vrlo često susreću liječnici hitnog prijma. U najvećem broju slučajeva riječ je o ozljedama koje zahtijevaju kratko razdoblje imobilizacije, a tek je u rijetkim slučajevima potrebno kirurško liječenje. Stoga, da se kod svakog djeteta osigura optimalan ishod, potrebno je poznavati rijetke prijelome članaka prstiju kod djece kod koje bi operativno liječenje bilo indicirano. Seymourov prijelom zahtijeva liječenje po načelima otvorenog prijeloma. Koštani mallet finger s prisutnom subluksacijom zgloba valjalo bi operativno stabilizirati. Subkapitalni i kondilarni prijelomi, kao i skijaški palac sa značajnom dislokacijom, indikacija su za kirurško liječenje. Kod kompleksnih dislokacija metakarpofalangealnog zgloba u najvećem je broju nužna otvorena repozicija i fiksacija. Avulzije volarne ploče su prijelomi koji mogu rezultirati ukočenošću proksimalnog interfalangealnog (PIP) zgloba u slučaju preduge imobilizacije, a u slučaju avulzijskih ozljeda u području dorzuma srednjeg članka treba uvijek isključiti pridruženu rupturu sagitalnog kraka ekstenzorne tetive.

Two cases which involved a massive avulsion injury of the lower extremities are presented. In both cases the treatment consisted of sequential debridement during the initial period after which negative pressure wound therapy was applied for a period of three to four weeks in order to enable the formation of a solid layer of granulation tissue and a clinically clean wound. Subsequently, INTEGRA® DRTwas fixed to the wound bed with negative pressure wound therapy. During the next three weeks INTEGRA® DRT „integrated“ which enabled split-thickness skin grafting with 0.2 mm thick grafts. In both cases the final outcome was functionally and cosmetically satisfying with near normal contours of the lower extremity restored. Negative pressure wound therapy for a period of three to four weeks enables control of the colonisation of the wound bed and a formation of a solid layer of granulation tissue. The application of INTEGRA® DRT enables formation of the neodermis which provides elasticity and better contours of the reconstructed tissue. A downside of this type of treatment is the price as well as the duration of therapy of about eight weeks.