Remodeling Potential of Phalangeal Distal Condylar Malunions in Children

Puckett, Benjamin N.; Glenn, Georgia R; Allan, Peljovich E.; Lourie, Gary M.; Floyd, Waldo E.

doi:10.1016/s0363-5023(09)60119-2

Cited by 11 publications

(16 citation statements)

References 8 publications

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“…This type of fracture occurs almost exclusively in children and have historically been mistaken for a physeal injury at the distal aspect of the phalanx, despite the proximal location of the physis in the phalanges of the fingers. 25 True lateral x-rays of the affected finger, without overlap of other fingers, must be obtained to determine the most appropriate course of treatment. Many of these fractures can be successfully reduced in a closed manner because they do not involve the articular surface.…”

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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Section: Phalangeal Neck Fracturesmentioning

confidence: 99%

10 Pediatric Hand Fractures

2018

Fractures of the Hand and Carpus

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“…[29][30][31][32] Remodeling may take years, and rotational and/or coronal plane malalignment will not reliably improve. Bony remodeling is most reliable in young patients with considerable growth remaining in whom the primary deformity is in the flexionextension plane.…”

Section: Handmentioning

confidence: 99%

What’s New in Pediatric Orthopaedics

Bae

Goldfarb²

2014

Journal of Pediatric Orthopaedics

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“…Due to the difficulty in appreciating the true extent of displacement on initial x-rays, it is not uncommon for children to present with delayed condylar malunions. While a number of techniques have been described to treat these patients, including early open osteotomy and late subcondylar fossa recession, Puckett et al recently reported on 8 patients treated nonoperatively and found that remodeling did occur and functional outcomes were good, suggesting that aggressive operative intervention may not be needed in all cases [53].…”

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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Remodeling Potential of Phalangeal Distal Condylar Malunions in Children

Cited by 11 publications

References 8 publications

10 Pediatric Hand Fractures

10 Pediatric Hand Fractures

What’s New in Pediatric Orthopaedics

Pediatric hand and wrist injuries

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