Remodeling Potential of Phalangeal Distal Condylar Malunions in Children

Comparison Between Buddy Taping With a Short-Arm Splint and Operative Treatment for Phalangeal Neck Fractures in Children

“…Because of the lack of awareness about their unstable nature, many previously reported phalangeal malunions have been treated with only buddy straps or flexible aluminum splints. 5,11 Our method of buddy taping with a short-arm splint helped maintain acceptable reduction without surgery. Sagittal displacement with posterior angulation in the lateral view is one of the most important features on the radiograph, and an accurate evaluation is crucial for diagnosis; however, it can be difficult to obtain such a radiograph due to the overlapping of fingers during immobilization.…”

“…22,23 However, remodeling in the coronal plane occurs to a lesser extent as compared with that in the sagittal plane due to the plane of the range of motion. 5 Therefore, accurate reduction in the coronal plane and rotation is important during initial treatment. In our study, the splint was applied to the functional position like fist position, so we could evaluate the rotation and we checked the coronal alignment in x-ray with buddy taping after splint off.…”

“…Translation was reported as the percentage of translation of the distal fragment relative to the mid-axial point of the shaft on the lateral image. 5 The percentage of translation displacement was quantified in an effort to describe the volar spike component that presumably blocks flexion of the affected joint. The clinical outcome was assessed using range of motion at the final follow-up visit and each patient was asked to make a fist with both hands to determine whether there was any rotational deformity.…”

“…[1][2][3] The factors that influence remodeling include age at the time of injury, the site of the fracture, and the involved plane of the range of motion. 4 In phalangeal neck fractures, the neck of the phalanx is remote from the physes 5 and there is a no remodeling potential for rotational malunion. Furthermore, fractures of the distal aspect of the proximal and middle phalanges tend to be inherently unstable in sagittal plane because the lack of tendon attachments to the cartilaginous cap allows dorsal displacement.…”

Pediatric Hand Fractures

“…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.…”