Nonunion and Avascular Necrosis Following Phalangeal Neck Fractures in Children

Al‐Qattan, Mohammad M.

doi:10.1016/j.jhsa.2010.03.038

Cited by 37 publications

(19 citation statements)

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“…Following phalangeal neck fractures, the blood supply to the phalangeal head comes from the collateral ligament attachments and, hence, the head is considered to be relatively ischemic (6). Therefore, during reduction and fixation of these fractures, the collateral ligaments should be protected.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, during reduction and fixation of these fractures, the collateral ligaments should be protected. Furthermore, the heat from multiple passes of K-wires through the head should be avoided because it may lead to avascular necrosis (6).…”

Section: Discussionmentioning

confidence: 99%

“…Several articles have discussed the various complications associated with these fractures such as vascular injury, malunion, nonunion, avascular necrosis of the phalangeal head, rotational deformity of the digit and extension lag/stiffness of the involved joint (3)(4)(5)(6)(7)(8)(9)(10)(11). A review of the English language literature did not reveal any study on iatrogenic comminution of the phalangeal head during reduction/fixation of phalangeal neck fractures.…”

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confidence: 99%

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Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures

Al‐Qattan

2012

Canadian Journal of Plastic Surgery

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Phalangeal neck fractures are fractures through the necks of the proximal or middle phalanges of the fingers, or through the neck of the proximal phalanx of the thumb, and occur more commonly in children (1) than in adults (2). Several articles have discussed the various complications associated with these fractures such as vascular injury, malunion, nonunion, avascular necrosis of the phalangeal head, rotational deformity of the digit and extension lag/stiffness of the involved joint (3-11). A review of the English language literature did not reveal any study on iatrogenic comminution of the phalangeal head during reduction/fixation of phalangeal neck fractures. In the present article, we present five cases involving this complication to increase awareness of its occurrence and to increase awareness that such a complication may result in medicolegal claims. MethodsThe author has developed a special interest in phalangeal neck fractures and receives referrals of complicated cases from the central province (population of approximately six million) of Saudi Arabia. A database containing records of phalangeal neck fractures over the past six years was reviewed for iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures. Over the six-year period (2006 to 2011), a total of 152 patients with phalangeal neck fractures were treated. Of these, five cases experienced iatrogenic comminution of the phalangeal head. The following data were documented for these five cases: age, sex, phalanx/digit involved, fracture type, and the presence or absence of ischemia of the fractured digit at the time of injury. Fracture type at the time of injury was documented according to the classification proposed by Al-Qattan (1) as follows: type I are undisplaced fractures; type II are displaced fractures with bone-to-bone contact between the proximal and distal fracture fragments; and type III fractures are displaced fractures with no bone-to-bone contact. Initial and secondary management of these fractures were also documented with particular attention devoted to the causes of comminution of the phalangeal head during management. At final follow-up, the net range of motion of the joints (defined as active flexion minus the extension lag at the same joint) of the fractured digits was recorded. Finally, cases in which medicolegal claims were filed were noted. Table 1 summarizes the results in the five patients studied (two children and three adults). In all cases, the injury was caused by entrapment of the digit in a closing door. None of the fractured digits showed evidence of ischemia at the time of injury. Results Case 1A four-year-old girl presented to hospital with a type III fracture of the middle phalanx of the little finger ( Figure 1A). Open reduction and K-wire fixation was performed through a dorsal approach. There were difficulties in achieving accurate reduction; therefore, the wire was passed through the phalangeal head twice. A longitudinal split of the phalangeal head was noted d...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures

Al‐Qattan

2012

Canadian Journal of Plastic Surgery

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“…For reasons not well understood, conservative treatment carries an additional risk for non-union in thumb phalangeal neck fractures and avascular necrosis in the small finger. 26 A classification by Al-Quattan using a case series of 66 of these fractures suggests that nondisplaced fractures heal well with splinting alone (Type I). The author found that displaced fractures with some remaining bony contact (Type II) were most likely to have good outcomes with operative reduction and fixation.…”

Section: Phalangeal Neck Fracturesmentioning

confidence: 99%

10 Pediatric Hand Fractures

2018

Fractures of the Hand and Carpus

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SummaryPediatric hand fractures are common childhood injuries. Identification of the fractures in the emergency room setting can be challenging owing to the physes and incomplete ossification of the carpus that are not revealed in the xrays. Most simple fractures can be treated with appropriate immobilization through buddy taping, finger splints, or casting. If correctly diagnosed, reduced and immobilized, these fractures usually result in excellent clinical outcomes. However, fractures may require operative stabilization if they have substantial angulation or rotation, extend into the joint, or cannot be held in a reduced position with splinting alone. Most fractures can be treated operatively with closed reduction and percutaneous pinning if addressed within the first week following the injury. In children, the thick, vascular-rich periosteum and bony remodeling potential make anatomic reductions and internal fixation rarely necessary. Most fractures complete bony healing in 3-4 weeks, with the scaphoid being a notable exception. Following immobilization, children rarely develop hand stiffness and formal occupational therapy is usually not necessary. Despite the high potential for excellent outcomes in pediatric hand fractures, some fractures remain difficult to diagnose and treat. Keywords Pediatric hand fractures; Pediatric hand injuriesA number of pediatric hand fractures have fairly innocuous presentations, but require early recognition and intervention to achieve satisfactory outcomes. Seymour fractures (open distal phalanx physeal fracture with proximal nail fold incarceration) must be identified and treated operatively to avoid infection, malunion, and nail deformities. Distal condylar phalangeal (DCP) fractures are difficult to address if not reduced at the time of injury. An osteotomy to correct a DCP malunion can be fraught with complications, and sagittal plane deformities may be able to remodel better than previously thought. Scaphoid waist fractures in adolescents, if not identified shortly after injury and immobilized appropriately, may result in non-union.

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“…Treatment is usually with bone grafting. While this is preferably done in childhood, it can be successful when delayed till adulthood if the patient or family prefers [50,51].…”

Section: Proximal Phalanxmentioning

confidence: 99%

Pediatric hand and wrist injuries

Williams

Lochner

2012

Curr Rev Musculoskelet Med

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In the last 40 years, childhood hand and wrist injuries have become progressively more common as children have become heavier and more active in high impact sports. The majority of children with such injuries do well, but treatment is not always straightforward. Distal radius fractures, scaphoid fractures, metacarpal and phalangeal fractures, nailbed injuries, and amputations are among the pediatric hand and wrist injuries most often seen by orthopedists. These are all discussed, with a focus on the most recent literature and areas of evolving controversy.

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Nonunion and Avascular Necrosis Following Phalangeal Neck Fractures in Children

Cited by 37 publications

References 18 publications

Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures

Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures

10 Pediatric Hand Fractures

Pediatric hand and wrist injuries

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