Pediatric phalanx fractures: Evaluation and management

Abstract

The hand is the major medium that children utilize to experience their surrounding world, making it particularly vulnerable to injury. Historically, the incidence of pediatric hand injuries followed a bimodal age distribution during the toddler/preschool years and another spike during adolescence. However, this trend may very well be changing with increased participation in youth athletics. A firm knowledge of pediatric hand pathoanatomy and the intricacies of fracture healing in the child are necessary in order to properly evaluate, diagnose, and treat these injuries. The exuberance of pediatric fracture healing and the potential for remodeling make nonoperative management the mainstay of treatment for most pediatric phalanx fractures. However, rapid fracture healing also results in a narrowed window for treatment. Therefore, the physician must identify those fractures that require special scrutiny and a low threshold for operative intervention. This chapter seeks to provide hand surgeons with a detailed overview of the epidemiology, pathoanatomy, evaluation, and treatment of specific phalanx fractures in the pediatric population. There is an emphasis on fracture subtypes that can become particularly problematic if the diagnosis is missed or initiation of treatment is delayed. These include Seymour fractures, condylar fractures and other intra-articular fractures, phalangeal neck fractures, and fractures with resultant malrotation. Although beyond the scope of this chapter, the evaluation and treatment of associated soft tissue injury deserve equal attention.