Wrist and Hand Skeletal Injuries in Children

Beatty, Ellen; Light, Terry R.; Belsole, Robert J.; Ogden, John A.

doi:10.1016/s0749-0712(21)01068-4

Cited by 58 publications

(4 citation statements)

References 43 publications

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“…The patient demographics were similar between the two groups, with a higher proportion of males and little finger injuries. This finding is consistent with previous studies on hand injuries, which have reported a higher incidence of hand fractures in males and little finger injuries being the most common [4,13,14]. The primary mechanisms of injury were falls and sports activities, reflecting the high level of physical activity in the pediatric population [15].…”

Section: Discussionsupporting

confidence: 92%

Single or double Kirschner wire fixation: which provides better outcomes for pediatric proximal phalanx base fractures?

Park,

Lee,

Kim

et al. 2023

JPHS

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Purpose: The most common hand fracture in children is seen at the base of the proximal phalanx. This study aims to compare clinical outcomes of single versus double Kirschner wire pinning for pediatric proximal phalanx base fractures.Patients and Methods: The retrospective study enrolled patients who underwent closed K-wire pinning for proximal phalanx base fractures from January 2016 to February 2022. We divided patients into two groups based on the number of K-wire inserted (single versus double). Demographics, removal of implant, complication rate were analyzed. Patients were asked to answer the Michigan Hand Outcomes Questionnaire (MHQ) by telephone. Data including fracture type, diaphyseal axis-metacarpal head angle (DHA) and Total Active Flexion Scale (TAFS) were analyzed.Results: This study included 37 pediatric patients with proximal phalanx base fractures, treated with either single (n = 10) or double K-wire (n = 27) fixation. The mean operation time was significantly shorter for the single K-wire group. No significant differences were observed in complication rates, TAFS, implant removal times, MHQ, or pre- and post-operative DHA between the two groups. Conclusion: The single K-wire technique demonstrates similar effectiveness to the double K-wire technique in treating pediatric proximal phalanx base fractures, with the added benefit of shorter operation time. Therefore, the choice between using one or two K-wires should be determined based on the surgeon’s proficiency and preference.

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Section: Discussionsupporting

confidence: 92%

Single or double Kirschner wire fixation: which provides better outcomes for pediatric proximal phalanx base fractures?

Park,

Lee,

Kim

et al. 2023

JPHS

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“…It has been hypothesized that this instability may be attributable to a more significant disruption in the periosteal sleeve in these injuries, which makes the fracture more likely to displace and remain unstable. 6 This phenomenon Plastic and Reconstructive Surgery • March 2022 may account for why in the series reported of juxtaepiphyseal fractures by Al-Qattan, the less displaced juxtaepiphyseal fractures did well with closed reduction alone, versus the more displaced juxtaepiphyseal fractures, which required more operative fixation (50 percent if malunion cases are included as candidates for operative fixation). However, if fracture pattern instability was attributable solely to periosteal tearing, we would expect a similar level of operative Kirschner wire fixation required for juxtaepiphyseal fractures and Salter-Harris type II fractures presenting with a similar level of displacement.…”

Section: Right)mentioning

confidence: 99%

“…Although most literature supports that the Salter-Harris type II injury remains the most common fracture pattern, 3,4 this is not universally supported. 5,6 Salter-Harris type II and juxtaepiphyseal fractures have very similar fracture patterns; however, the subtle differences on radiographs are important to recognize. Salter-Harris type II fractures traverse the physis with transition through a portion of the metaphysis of the phalanx (Fig.…”

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confidence: 99%

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Pediatric Juxtaepiphyseal Phalangeal Fractures Are Distinct from Salter-Harris Type II Fractures and More Frequently Need Operative Fixation

Stash

Posorske

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Salter-Harris type II fractures are the most common pediatric phalangeal fracture. A juxtaepiphyseal fracture is a distinct fracture pattern that, although similar in radiographic appearance, occurs 1 to 2 mm distal to the growth plate. Although subtle, there are important differences in the behavior and management of these fracture types. The purpose of this study was to compare these two fracture patterns in terms of clinical features and treatment. Methods: An institutional review board–approved retrospective chart review was conducted of patients presenting to our tertiary care pediatric hospital. One hundred fifty-eight patients with either Salter-Harris type II or juxtaepiphyseal phalangeal fractures were identified. Primary outcomes analyzed included angulation at initial presentation, stability of reduction if attempted in the emergency department, and need for operative fixation with and without Kirschner wire fixation, with final angulation measurements. Results: Salter-Harris type II fractures were more common than juxtaepiphyseal fractures (83 percent versus 17 percent, respectively). There was no significant difference between the two fracture types in the patient’s age, sex, or mechanism of injury. Juxtaepiphyseal fractures were radiographically more angulated on presentation than Salter-Harris type II fractures (p = 0.02). Juxtaepiphyseal fractures required significantly more operative fixation by closed reduction and percutaneous pinning compared to Salter-Harris type II fractures (42.9 percent versus 10.8 percent, respectively; p = 0.002). There was no difference in final outcomes obtained between the two groups. Conclusions: Juxtaepiphyseal phalangeal fractures are a distinct entity from Salter-Harris type II fractures. Presenting with significantly more radiographic angulation and clinical instability, juxtaepiphyseal fractures more frequently required operative fixation. Recognizing the differences between these pediatric fracture types is important to help guide clinical management for successful healing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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