A Comparison of Casting Versus Splinting for Nonoperative Treatment of Pediatric Phalangeal Neck Fractures

Liao, Janice C.Y.; Huan, Sarah K W; Tan, Ruth En Si; Lim, Jin Xi; Chong, Alphonsus K.S.; De, Soumen Das

doi:10.1097/bpo.0000000000001687

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…If malrotation is not present, extra-articular phalangeal neck fractures in children remodel and have good functional outcomes without a surgical procedure 73,74 . Liao et al 75 compared cast immobilization (19 patients) and hand or finger-based splint immobilization (28 patients) for phalangeal neck fractures. At the final follow-up (at a mean of 9.4 weeks), all children had the ability to make a full composite fist with a tipto-palm distance of 0 mm.…”

Section: Pediatric Fracturesmentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

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The intent is to serve as an update of the hand surgery literature for the practicing general orthopaedic surgeon. Carpal Tunnel SyndromeCarpal tunnel syndrome is one of the most common disorders in hand surgery. Nevertheless, the optimum method for diagnosis remains controversial. A growing body of evidence suggests that electrodiagnostic studies [1][2][3][4] are not more sensitive and specific than diagnosis by ultrasound or clinical history and examination. D'Auria et al. 5 examined the role of electrodiagnostic studies compared with clinical judgment and found that the utility of electrodiagnostic studies may be greatest in patients for whom a diagnosis of carpal tunnel syndrome is questionable. Even so, electrodiagnostic studies are performed in many patients with carpal tunnel syndrome 6 . Less expensive, office-based diagnostic tools such as the Carpal Tunnel Syndrome 6 (CTS-6), a 26-point scale that incorporates aspects of the history and clinical examination to predict the probability of carpal tunnel syndrome, and ultrasound will likely supplant the routine use of electrodiagnostic studies for carpal tunnel syndrome.Strong evidence exists for the use of night splints and corticosteroid injections for early treatment of carpal tunnel syndrome. In a comparison of the 2 treatments, 100 patients with a diagnosis of carpal tunnel syndrome were randomized to a night splint or a corticosteroid injection 7 . In the 95 patients who completed follow-up, corticosteroid injections were superior in terms of nocturnal paresthesias, pain, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.A novel study on hand function with decreased sensation showed that a digital nerve block to the thumb had the greatest negative impact on dexterity and a loss of sensation in the index and long fingers caused decreased grip and chuck pinch strength, thus explaining the common symptoms of decreased dexterity and strength in patients with carpal tunnel syndrome 8 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G899).

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Section: Pediatric Fracturesmentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

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“…Non-operative treatment to wait for fracture remodeling was initially discredited for type II phalangeal neck fractures [4][5][6], because of little remodeling of malunited phalangeal neck fractures due to the distance from physis [1,6]. However, multiple case reports on children have shown remodeling of phalangeal neck fractures; these authors believe that conservative treatment can achieve results similar to surgery [7][8][9][10]. Generally, the remodeling ability of fractures in children depends on the age of patient, the bone involved, proximity to the joint, and orientation to the joint axis [11].…”

Section: Introductionmentioning

confidence: 99%

Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture

Wang

Huang

et al. 2023

Journal of Pediatric Orthopaedics B

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To compare outcomes of type II phalangeal neck fractures in children who received closed reduction followed by splinting immobilization or by K-wire fixation. Furthermore, we analyzed the remodeling potential of residual deformities and the relationship between age and outcomes. Patients in Children’s Hospital of Fudan University, Xiamen Hospital were included in the study from October 2015 to October 2018. We compared outcomes between the conservation group and operation group. Remodeling of residual deformities was calculated on a series of anteroposterior and lateral radiography. The correlation between age and outcomes was analyzed using Spearman’s rank correlation coefficient. Forty patients (25 males) were enrolled. Nineteen patients had subtype IIa, 19 subtype IIb, and two subtype IIc fractures. Left hands were affected more than right hands, and small finger and proximal phalanx were more frequently involved. There were no significant differences between conservation group and operation group among excellent, good, and fair outcomes. And the outcomes were not significantly different between the IIa and IIb subtypes. An average sagittal remodeling rate was 88.5%, and coronal remodeling rate was 56.71%, respectively, in 13 patients with residual deformities. There was a significant correlation between age and final outcomes. Closed reduction and stable splint fixation may be an effective and economical initial treatment option. Fracture subtype does not seem to be a key factor for choosing treatment options. The fractured phalangeal neck had remodeling potential whether on sagittal or coronal plane. Younger age might be a predictor of better outcomes in children with type II phalanx neck fractures.

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“…[1][2][3][4][5][6] Immobilization for phalangeal fractures is a well-established treatment in hand therapy. 1,[6][7][8][9][10][11] The majority of phalangeal fractures in children can be managed nonsurgically with the use of a cast or splint to immobilize the fracture. 2,6,7,10,12,13 While casts are associated with potential problems such as skin irritation, malodor, and skin maceration, 8,9 splinting has the benefits of increased comfort and hygiene as compared with casting.…”

mentioning

confidence: 99%

“…1,[6][7][8][9][10][11] The majority of phalangeal fractures in children can be managed nonsurgically with the use of a cast or splint to immobilize the fracture. 2,6,7,10,12,13 While casts are associated with potential problems such as skin irritation, malodor, and skin maceration, 8,9 splinting has the benefits of increased comfort and hygiene as compared with casting. 10 Hand-based splinting of proximal phalangeal fractures, immobilizing the affected and adjacent digit with light-weight thermoplastic, provides a favorable option in relation to hygiene, comfort, and function.…”

mentioning

confidence: 99%

“…2,6,7,10,12,13 While casts are associated with potential problems such as skin irritation, malodor, and skin maceration, 8,9 splinting has the benefits of increased comfort and hygiene as compared with casting. 10 Hand-based splinting of proximal phalangeal fractures, immobilizing the affected and adjacent digit with light-weight thermoplastic, provides a favorable option in relation to hygiene, comfort, and function. 10,13 Fracture healing in children is accelerated when compared with adults allowing for shortened intervals of immobilization.…”

mentioning

confidence: 99%

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Advances in Hand Therapy: Best Practice in Conservative Management of Proximal Phalangeal Fractures in Children

Kilty,

Baxter,

McKay

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Proximal phalangeal fractures are one of the most commonly treated hand injuries in children. Conservative management of these fractures is often to splint for 5 weeks post injury, despite children presenting as clinically healed at 3 weeks post injury. Therefore, we investigated the effect of splinting for only 3 weeks in children who present with clinically healed proximal phalangeal fractures at 3 weeks compared with usual care. Methods: Participants (n=80, aged 10.3 ±2.5 years) presenting to the Hand Clinic of a tertiary Children’s Hospital in Sydney, Australia, were randomly allocated into a Current Protocol and a New Protocol group. Following were the inclusion criteria: aged between 5 and 16 years; present with an non-displaced or minimally displaced and stable fracture; no surgical intervention; assessed as clinically healed at 3-week visit. The primary outcome measure was total active motion (TAM) of the injured digit compared with the contralateral digit (deg), at 5 weeks post injury. Secondary outcome measures were grip strength, and a parent-reported questionnaire. Statistical analysis used χ2 test and the absolute difference described by a 90% CI. The New Protocol was considered noninferior if the 90% CI overlap was > 20% of the Current Protocol. Analysis was by intention to treat. Results: There was a 10% loss to follow up at 5 weeks (Current Protocol =4, New Protocol =4). All CIs between groups overlapped by >10%. TAM 90% CI for Current Protocol was 17.7 to 5.4 degrees and for the New Protocol was 4.7 to 1.6 degrees. Conclusions: A change in practice is warranted to cease immobilization for children with conservatively managed proximal phalangeal fractures who present as clinically healed at 3 weeks. Therapist assessment of fracture healing is an appropriate indicator for intervention and can be utilized in a therapist-led model of care. Level of Evidence: Level 1—noninferiority randomized control trial with 2 parallel arms.

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A Comparison of Casting Versus Splinting for Nonoperative Treatment of Pediatric Phalangeal Neck Fractures

Cited by 8 publications

References 19 publications

What’s New in Hand and Wrist Surgery

What’s New in Hand and Wrist Surgery

Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture

Advances in Hand Therapy: Best Practice in Conservative Management of Proximal Phalangeal Fractures in Children

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