Phalangeal Shaft Fractures

Abstract

Children use their hands to explore and interact with their surroundings and consequently frequently injure their hands. As such they frequently sustain fractures of the phalanges, which are the most common hand injuries seen in children. The border digits – the small finger and thumb – are the most frequently fractured in children. Many infants and toddlers injure their hands at home, but the incidence of sports-related hand injuries increases until a peak at age 12. Oftentimes, subtle fractures can be missed initially, as they are stable and do not hurt significantly when contact is avoided. Phalangeal shaft and neck fractures commonly occur in young patients from sports-related activity or can be seen in crush injuries to the digit (Abzug et al. 2016). The injury can be mild enough that patients may not seek care for several days following the injury. Most patients present with edema and ecchymosis centered over the involved bone, most frequently the proximal phalanx. Range of motion may be limited due to pain, edema, or fracture displacement. Fractures through the shaft of the phalanx are more often unstable and may require operative intervention to control alignment and prevent displacement. Malrotation or scissoring is common and will not remodel and must be identified and treated appropriately (Fig. 1). Almost all phalangeal shaft fractures that require operative intervention can be treated closed with percutaneous K-wire fixation, and open reduction and internal fixation is typically only required for open fractures or those with soft tissue interposition .