Outcomes of Phalangeal Neck Fractures in a Pediatric Population

Purpose Displaced pediatric phalangeal neck fractures are regarded as unstable, and hence, surgical fixation is traditionally recommended. In our experience, some patients with displaced fractures treated nonsurgically healed with a good clinical outcome and no further displacement. We studied the outcome of displaced phalangeal neck fractures treated nonsurgically with attention to the change in fracture displacement over time and hypothesized that displaced phalangeal neck fractures can be treated nonsurgically with maintenance of acceptable radiological parameters. Methods A retrospective review of 35 patients aged 16 and younger was conducted. Included patients had at least 10 degrees of angulation or 25% translation in either the coronal or the sagittal plane, with no malrotation. Angulation and translation of the distal fracture fragment in the coronal and sagittal planes was measured from radiographs taken at 2 intervals-within 7 days of the injury and at least 21 days after the injury. Initial and final measurements were compared to determine the amount of fracture displacement that occurred. Results Thirty-five patients with type II A, B, and C fractures (classification according to Al-Qattan) comprised our study sample. Twelve patients had undergone manipulation and reduction. Average radiological follow-up was 4.3 months (range, 0.7-86 months; median, 1.2 months; SD, 14.7). These fractures treated nonsurgically did not displace as the fracture healed, suggesting that type II fractures, although traditionally regarded as unstable, may maintain their radiological parameters without surgical fixation. Conclusions Our findings suggest that displaced phalangeal neck fractures do not necessarily displace with nonsurgical treatment. (Copyright (C) 2020 by the American Society for Surgery of the Hand. Published by Elsevier Inc.)