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d’Oliveira L, Craviotto M. Antegrade Intramedullary Screws in Metacarpal Fractures of Pediatric Patients. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:695-700. [PMID: 37790818 PMCID: PMC10543810 DOI: 10.1016/j.jhsg.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/15/2023] [Indexed: 10/05/2023] Open
Abstract
Metacarpal fractures are common injuries in pediatric patients. In adults, cannulated intramedullary screws are an excellent stabilization option for metacarpal fractures and are widely used, but in pediatric patients with open physes, their use is a relative contraindication. The risk of injury to the physis in classic retrograde screw placement makes this type of osteosynthesis not an option. We present the case of an 8-year-old patient with fractures of two adjacent metacarpals with rotational malalignment and scissoring, in which closed reduction was performed, and stabilization with cannulated intramedullary screws using antegrade placement to avoid injury to the physis.
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Affiliation(s)
- Lucia d’Oliveira
- Pediatric Plastic Surgery. Military Hospital, Montevideo, Uruguay
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2
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Wang K, Du W, Deng C, Hu N, Zhuang W. Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing. J Int Med Res 2023; 51:3000605231174981. [PMID: 37243605 DOI: 10.1177/03000605231174981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE This retrospective study compared two minimally invasive surgical methods for fifth metacarpal neck fractures in adolescents: percutaneous Kirschner wire (K-wire) fixation and elastic stable intramedullary nailing (ESIN). METHODS This study involved 42 adolescents aged 11 to 16 years with fifth metacarpal neck fractures treated by either K-wire fixation (n = 20) or ESIN (n = 22). The palmar tilt angle and shortening were compared on radiographs preoperatively and 6 months postoperatively. Total active range of motion (TAM), the visual analogue scale score for pain, and the Disabilities of the Arm, Shoulder and Hand score for upper limb function were recorded at 5 weeks, 3 months, and 6 months postoperatively. RESULTS The mean TAM was significantly greater in the ESIN than K-wire group at all postoperative time points. The mean external fixation time was 2 weeks longer in the K-wire than ESIN group. One patient in the K-wire group developed infection. There was no statistically significant difference between the two groups in other postoperative outcomes. CONCLUSIONS ESIN fixation has the advantages of greater stability, better activity, a shorter external fixation time, and a lower infection rate than K-wire fixation in the treatment of fifth metacarpal neck fractures in adolescents.
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Affiliation(s)
- Kai Wang
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Weibin Du
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Changzong Deng
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Ningrui Hu
- Hubei Chinese Medical University, Wuhan, China
| | - Wei Zhuang
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
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3
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Lee SJ, Merrison H, Williams KA, Vuillermin CB, Bauer AS. Closed Reduction and Immobilization of Pediatric Fifth Metacarpal Neck Fractures. Hand (N Y) 2022; 17:416-421. [PMID: 32940066 PMCID: PMC9112733 DOI: 10.1177/1558944720942890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is no clear consensus for the criteria for closed treatment of metacarpal neck fractures. Our objective was to determine whether closed reduction of pediatric fifth metacarpal neck fractures results in a clinically meaningful improvement in radiographic angulation. METHODS We performed a retrospective cohort study of pediatric patients with fifth metacarpal neck fractures treated with closed reduction. Radiographs were examined for sagittal fracture angulation measured post-reduction, 2 to 14 days post-reduction, and 21 to 35 days post-reduction. We compared the angulation for open versus closed physes, initial fracture angulation greater than or less than 50°, and immobilization in extension versus intrinsic-plus position. RESULTS Fifty-four subjects were included with an average age of 14.8 years at the time of injury and a mean initial fracture angulation of 42.7°. The improvement in fracture angulation was 8.3° (90% confidence interval [CI], 5.9-10.7) on post-reduction radiographs, 8.5° (90% CI, 6.1-10.9) at 2 to 14 days post-reduction, and 4.3° (90% CI, 1.4-7.2) at 21 to 35 days post-reduction. Subgroup analysis showed that patients with injury angle greater than or equal to 50° had significantly higher mean reductions than those with injury angle less than 50°. In this group, angulation improved 15.6° (90% CI, 8.5-22.7) post-reduction, 15.1° (90% CI, 10.1-20.1) at 2 to 14 days post-reduction, and 16.5° (90% CI, 10.4-22.6) at 21 to 35 days post-reduction. CONCLUSIONS Closed reduction of pediatric fifth metacarpal neck fractures with initial fracture angulation less than 50° may not meaningfully improve sagittal alignment. For fractures with initial angulation greater than or equal to 50°, closed reduction resulted in clinically important, statistically significant, and lasting improvements of 16.5°.
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Affiliation(s)
| | | | | | | | - Andrea S. Bauer
- Boston Children’s Hospital, MA, USA,Andrea S. Bauer, Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, HUN 213, Boston, MA 02115, USA.
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Tan C, Depiazzi J, Bear N, Blennerhassett L, Page R, Gibson N. Exercise handout and one-on-one hand therapy for management of stiffness after plaster cast immobilization of simple phalangeal and metacarpal fractures in children: A randomized, noninferiority trial. J Hand Ther 2021; 34:423-432.e7. [PMID: 32571602 DOI: 10.1016/j.jht.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a noninferior, single-blind, randomized controlled trial. INTRODUCTION Joint stiffness is common after plaster cast immobilization for simple phalanx and metacarpal fractures in children. The limited literature suggests this joint stiffness in children resolves without one-on-one therapy; however, without robust studies confirming that there is no detrimental effect from withdrawing treatment, many children are still referred. PURPOSE OF THE STUDY The purpose of this study was to determine if an educational handout for self-management of stiffness is noninferior to one-on-one hand therapy for achieving full range of motion (ROM). METHODS Participants were randomly assigned to group one who received the handout or group two who received hand therapy in addition to the handout. The ROM was measured by composite flexion and total active motion (TAM). The noninferiority margin was 10% difference between the two groups in the proportion of participants who achieved full ROM at two weeks after cast removal. RESULTS Sixty participants in each group completed the study. Group difference for composite flexion was 1.7% (95% CI: -3.9% to 7.2%), demonstrating noninferiority. Group difference for TAM was inconclusive at 8.3% (95% CI: -2.1% to 18.7%). Sensitivity analysis adjusting for participants with full composite flexion at the baseline resulted in the group difference for composite flexion of 3.1% (95% CI: -3.6% to 9.8%), maintaining noninferiority, but group difference for TAM at 10.4% (95% CI: 0.0% to 20.9%), was inconclusive with the handout group significantly worse. CONCLUSION An educational handout is noninferior to hand therapy for achieving full ROM in composite flexion but not TAM. This needs to be taken into consideration for changing clinical practise.
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Affiliation(s)
- Cheng Tan
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia.
| | - Julie Depiazzi
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Child Adolescent Health Service, Perth, Western Australia, Australia
| | - Lewis Blennerhassett
- Department of Plastics and Reconstructive Surgery, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Rohan Page
- Department of Plastics and Reconstructive Surgery, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Noula Gibson
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia
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Qiao F, Qu D, Cheng L, Jiang F. Closed reduction of severely angulated Rockwood and Wilkins' type C thumb Metacarpal Base fractures in children: case series. BMC Musculoskelet Disord 2021; 22:775. [PMID: 34511084 PMCID: PMC8436467 DOI: 10.1186/s12891-021-04665-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Management of severely angulated Rockwood and Wilkins' type C (RW-C) thumb metacarpal base fractures in children is challenging. We report experiences of percutaneous leverage reduction and dual antegrade crossing Kirschner (DACK) wire fixation in these fractures, aiming to assess the results using our reduction technique. METHODS From October 2011 to September 2015, A total of 17 patients with severely angulated RW-C thumb metacarpal base fractures were treated at our hospital. The injured arm, including the entire first ray, was immobilized with a thumb-spica cast for 4-6 weeks and evaluated radiologically and clinically. Percutaneous leverage reduction and DACK wire fixation were successfully performed for 17 patients. No patients were treated with open reduction. 16 patients were followed up for a mean of 32 months (range 24-41 months). The results were assessed using the modified Mayo score. The level of significance was set to be p < 0.05. RESULTS The patients included 9 girls (56.2%) and 7 boys (43.8%), with an average age of 10.8 years (range 7.5 to 14.0 years). Percutaneous leverage reduction and DACK wire fixation were successfully performed within an average total surgery time of 20 min (range 12-32 min). Bone union was achieved in all patients within a mean time of 4.2 weeks (range 4-6 weeks). The average angulation (preoperation: 50.5° (range 40.8°-67.0°) vs postoperation: 5.0° (range 0.0°-7.0°)) significantly changed from pre to post-surgery (P < 0.05). The clinical outcomes were evaluated by the modified Mayo score: 15 patients had an excellent outcome, and one patient had a good outcome. Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion, growth arrest in the proximal epiphysis. Only one patient suffered from a superficial infection, which was resolved after the removal of the k-wires and the administration of oral antibiotics. CONCLUSION Our percutaneous leverage technique with DACK wire fixation can be successfully used to treat these fractures. This technique is simple to learn and minimally invasive, and the results are satisfactory. It may be an appropriate choice for the treatment of irreducible RW-C fractures.
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Affiliation(s)
- Fei Qiao
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 Shandong China
- Department of Pediatric Orthopaedic, Dalian Women and Children’s Medical Center (group), Dalian, 116012 Liaoning China
| | - Dehai Qu
- Department of Pediatric Orthopaedic, Dalian Women and Children’s Medical Center (group), Dalian, 116012 Liaoning China
| | - Lei Cheng
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012 Shandong China
| | - Fei Jiang
- Department of Pediatric Orthopaedic, Dalian Women and Children’s Medical Center (group), Dalian, 116012 Liaoning China
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Gu S, Zhou L, Huang Y, Xie R. The curative effect analysis of a modified Kirschner wires and locking plate internal fixation method for the fifth metacarpal neck fracture. J Orthop Surg Res 2021; 16:491. [PMID: 34384465 PMCID: PMC8359124 DOI: 10.1186/s13018-021-02627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the efficacy of a modified internal fixation method for the treatment of fifth metacarpal neck fracture. METHODS From March 2018 to December 2019, 12 patients with the fifth metacarpal neck fractures of the hands were treated with the Kirschner wires and locking plate internal fixation method. Each patient's gender, age, dominant hand, injured hand, trauma mechanism, preoperative and postoperative deformity (angulation and the length of the fifth metacarpal), the range of motion of the metacarpophalangeal joint and grip strength of each side, the time of return to work, and follow-up time were recorded and calculated. RESULTS The mean follow-up time was 16.8 months, and the angulations of preoperative and postoperative deformity were 40.0 ± 3.7°and 17.6 ± 1.7°, respectively. The length of the fifth metacarpals of preoperative and postoperative deformity were 51.5 ± 2.1 mm and 60.0 ± 1.8 mm, respectively. At the last follow-up, the range of motion of the fifth metacarpophalangeal joint of the injured side and the contralateral side were 84.3 ± 3.6°and 86.5 ± 2.0°, and the grip strength of the injured side and the contralateral side were 74.8 ± 6.1 LB and 78.6 ± 8.3 LB, respectively, without statistically significant differences. QDASH score was 2.0 ± 1.0, and the time of return to work was 6.0 ± 0.7 weeks. CONCLUSION The modified internal fixation method is one of the alternative treatments for the fifth metacarpal neck fracture with good curative effects.
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Affiliation(s)
- Song Gu
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Long Zhou
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Yinjun Huang
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Renguo Xie
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China.
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Kiely AL, Griffin M, Jeon FHK, Nolan GS, Butler PE. Phalangeal and Metacarpal Fractures in Children: A 10-Year Comparison of Factors Affecting Functional Outcomes in 313 Patients. J Hand Microsurg 2021; 15:124-132. [PMID: 37020613 PMCID: PMC10069998 DOI: 10.1055/s-0041-1730885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Introduction
It is widely believed that fractures in children have excellent clinical outcomes due to their capacity to remodel. There are, however, certain fractures that require careful management to avoid long-lasting functional impairment. Functional outcomes following hand fractures in children are poorly studied.
Materials and Methods
We performed a retrospective cohort study of consecutive children and adolescents who had operative treatment for metacarpal and phalangeal fractures (2008–2018). Tuft fractures and replantations were excluded. Functional outcomes were measured by total active motion (TAM) scoring, where a “good” outcome = TAM > 75%. Fractures were categorized by location, classification, and by the fixation they required.
Results
Three hundred thirteen children were included. For proximal phalangeal fractures, those treated by manipulation under anesthesia, had a higher proportion of “good” functional outcomes than Kirschner-wire or open reduction internal fixation at discharge from hand therapy (
p
= 0.043). Middle phalanx fractures had excellent functional outcomes, with no difference between fixation methods (
p
= 0.81). For metacarpals, there was no statistically significant difference in functional outcomes across all managements (
p
= 0.134). Fractures in the thumb had poorer postoperative function at mean 7.26 weeks than those in the long fingers (
p
< 0.0001), and the data suggested a trend toward worse outcomes in the distal phalanx, pediatric Bennett fractures, Seymour fractures, and oblique fractures.
Conclusions
Fractures in the thumb and phalangeal fractures that require percutaneous or open fixation may need closer early postoperative monitoring in children to optimize their potential for good function.
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Affiliation(s)
- Ailbhe L. Kiely
- Department of Plastic & Reconstructive Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, United Kingdom
- Address for correspondence Ailbhe Kiely, MB BCh BAO MRCS Department of Plastic & Reconstructive SurgeryQueen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2THUnited Kingdom
| | - Michelle Griffin
- Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, United Kingdom
| | - Faith Hyun Kyung Jeon
- Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, United Kingdom
| | - Grant S. Nolan
- Whiston Hospital, Warrington Road, Prescot, Merseyside, United Kingdom
| | - Peter E. Butler
- Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, United Kingdom
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8
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Fan XL, Wang J, Zhang DH, Mao F, Liao Y, Xiao R. Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth. BMC Musculoskelet Disord 2021; 22:546. [PMID: 34130660 PMCID: PMC8204464 DOI: 10.1186/s12891-021-04436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0–4), the mean VAS was 0.19 ± 0.60 (range, 0–2), and the mean grip strength was 91.55 %±4.52 % (range, 85–101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. Conclusions Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. Level of evidence Level IV. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04436-w.
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Affiliation(s)
- Xiao-Lei Fan
- Department of Orthopaedics, Xiangya Hospital, Central South University, 410008, Changsha, China.,Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Jian Wang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - De-Hua Zhang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Feng Mao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Yi Liao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China.
| | - Rui Xiao
- Department of Surgical Center, Karamay Central Hospital of Xinjiang, 834000, Karamay, China. .,Karamay District Center for Disease Control and Prevention , 834000, Karamay, China.
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A Comparison of Casting Versus Splinting for Nonoperative Treatment of Pediatric Phalangeal Neck Fractures. J Pediatr Orthop 2021; 41:e30-e35. [PMID: 32991491 DOI: 10.1097/bpo.0000000000001687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Phalangeal neck fractures account for 13% of pediatric finger fractures. Al Qattan type I (undisplaced) fractures are treated nonoperatively. There is increasing evidence that Type 2 (displaced) fractures achieve remarkable fracture remodeling with nonoperative treatment and patients frequently make a full functional recovery. The options available for nonoperative management of these fractures are either a plaster cast or a removable splint. We hypothesized that there would be no significant difference in radiologic outcome in pediatric phalangeal neck fractures (Types I and II) treated with splint or cast immobilization. METHODS This is a retrospective study of patients aged 18 and below with phalangeal neck fractures treated nonoperatively from 2008 to 2017. Radiographs were compared at <1 week and >3 weeks after injury. Translation and angulation in coronal and sagittal planes were measured and compared using Student t tests. Baseline variables were compared using χ or Fisher exact tests. RESULTS There were 47 patients with phalangeal neck fractures treated nonoperatively during the study period. There were 9 type I and 38 type II fractures. The mean age was 10 years with 40 males and 7 females. Fractures occurred in 33 dominant and 14 nondominant hands and involved 29 proximal and 18 middle phalanges. Nineteen children were treated in casts and 28 with removable splints. The mean duration of follow-up was similar between the 2 groups. The most affected phalanx was the proximal phalanx of the small finger and the most common fracture pattern was type IIA. There was no significant difference in clinical and radiologic outcomes between children who were treated in casts and those treated in removable splints. CONCLUSION There was no difference in the clinical and radiologic outcomes in pediatric phalangeal neck fractures treated with cast or splint immobilization. Splinting has the added benefits of increased comfort and hygiene and we routinely offer splinting as a viable alternative in the nonoperative treatment of Al Qattan type I and type II phalangeal fractures. TYPE OF STUDY/LEVEL OF EVIDENCE Level III-therapeutic studies.
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Spies CK, Langer M, Müller LP, Oppermann J, Löw S, Unglaub F. [Ligamentous lesions and instability of the finger joints]. DER ORTHOPADE 2017; 47:175-188. [PMID: 29264616 DOI: 10.1007/s00132-017-3510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Joint capsule and ligamentous lesions are common injuries of the upper extremities. Athletes are particularly inclined to suffer from these injuries. Clinical and radiological examinations are the cornerstone of an adequate treatment. Ultrasound-based diagnostics as a non-invasive and dynamic investigation method are gaining increasing relevance based on the development of high resolution probes. A correct interpretation of the findings is only feasible with a comprehensive knowledge of the anatomy. The most important goal is stability as a prerequisite for early active and passive motion with unrestricted range of motion.
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Affiliation(s)
- C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland.
| | - M Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - S Löw
- Praxis für Handchirurgie und Unfallchirurgie, Wolfgangstr. 2, 97980, Bad Mergentheim, Deutschland
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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12
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Pediatric hand injuries: essentials you need to know. Emerg Radiol 2013; 21:197-206. [PMID: 24158746 DOI: 10.1007/s10140-013-1158-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
The hand is a common site of injury in children and adolescents. The most common mechanism of injury in younger children is crush injury resulting from the hand caught in a closing door while most fractures in teenagers result from recreational sports. Accurate diagnosis of hand fractures is a requisite for timely management of these injuries in order to restore normal function and achieve a satisfactory outcome since poorly treated injuries can have significant functional consequences. Metacarpal and phalangeal fractures can be difficult to diagnose at radiography due to their relatively small size leading to potential delays in treatment. Recognition of common fracture locations and patterns is essential in ensuring prompt and appropriate treatment.
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13
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Jehanno P, Mas V, Fitoussi F, Frajman JM, Valenti P, Mazda K. [Metacarpal osteoarticular injuries in children]. CHIRURGIE DE LA MAIN 2013; 32 Suppl 1:S29-S38. [PMID: 23796792 DOI: 10.1016/j.main.2013.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 01/05/2013] [Accepted: 02/16/2013] [Indexed: 06/02/2023]
Abstract
Metacarpal fractures and dislocations in the fingers are common injuries in children's hands. Most of these can be treated successfully non-operatively, although a subset requires more aggressive treatment. Results following appropriate care in children are generally good. Twenty percent of them need a reduction, need for surgical stabilization is rare. Each injury is presented, including diagnostic, therapeutic principles, pitfalls to prevent and potential complications.
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Affiliation(s)
- P Jehanno
- Urgences mains-enfants, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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14
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Abstract
Twenty-eight patients with 31 closed fractures (27 acute fractures and four with malalignment after conservative treatment) of the metacarpal bones 2-5 were treated with only one elastic stable intramedullary nail and followed prospectively. Treatment protocol was without immobilization or physiotherapy. These patients were reviewed at a mean follow-up time of 15 months for ultrasound results as well as functional outcome concerning complications, pain, range of motion, and grip strength measured with a Vernier-Dynamometer. Satisfaction of the patients was investigated by Clients Satisfaction Questionnaire. Radiographs before nail removal, ultrasound, and clinical examination always showed complete union of the fracture without deviation of axis. All patients gained full range of motion without any limits in daily activity and sports. There was no loss of grip strength compared with the other hand. Patients' satisfaction was very high, especially because of almost no postoperative pain and lack of immobilization. This method can be offered as an effective and safe alternative in the treatment of closed displaced fractures of the 2-5 metacarpus without significant complications.
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Conservative treatment of stable volar plate injuries of the proximal interphalangeal joint in children and adolescents: a prospective study. Pediatr Emerg Care 2009; 25:547-9. [PMID: 19755884 DOI: 10.1097/pec.0b013e3181b4f471] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to assess a standard conservative management for stable volar plate injuries of the proximal interphalangeal joint in children and adolescents. No study is available regarding this subject for this age group. METHODS A prospective study was performed on 37 consecutive patients (aged between 9 and 15 years; mean, 13 years) with stable acute volar plate injuries of the proximal interphalangeal joints, including 22 avulsion fractures without dislocation. All patients had a standardized conservative treatment consisting of a dorsal aluminum extension block splinting at a 15-degree flexion for 10 days, followed by a spontaneous mobilization and taping to adjacent fingers for sports only. At follow-up visits, active and passive ranges of motion, swelling of the affected joints, analgesic intake, and pain perception by the patient were recorded. Regular follow-up consisted of standardized assessments at 2, 6, and 12 weeks, with additional consultations if symptoms persisted. RESULTS Healing was uneventful, and hand therapy was not necessary to regain full range of motion in 32 of 33 children with a regular follow-up. The only flexion contracture observed responded well to splinting. Of the 33 patients, 31 had an excellent outcome and 2 had a good outcome. CONCLUSIONS Dorsal extension block splinting was an efficient, simple, well-tolerated treatment for stable volar plate injuries of the proximal interphalangeal joint in a preliminary series of patients younger 16 years. Flexion contractures were rare and responded well to dynamic splinting.
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Täger G, Podleska LE, Ruchholtz S, Sommerfeldt D, Nast-Kolb D. [Fractures close to the epiphysis in children. Part I: upper extremities]. Unfallchirurg 2007; 110:867-82; quiz 883. [PMID: 17896094 DOI: 10.1007/s00113-007-1336-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fractures in children require special knowledge and skills due to the differences in biological and biomechanical properties of growing skeletons. Children suffer from fractures of the upper extremities much more than fractures of the lower extremities. While fractures of the diaphysis have a high regenerative and proliferation potential, impairment of the growth plate with consecutive disturbance of growth can be found more often in fractures close to the epiphysis. Most epiphysis fractures in children can be identified by a set of 2-plane X-ray images but precise knowledge about the skeletal maturation is required. In order to correctly decide about treatment regimes (conservative versus operative treatment) the limitations and limits of the ability of bone to correct misalignment must be anticipated. Clinical examination following fracture healing is mandatory to recognize differences in length, misalignment and deficits in function, which should receive further treatment.
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Affiliation(s)
- G Täger
- Klinik für Unfallchirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstrasse 55, 45122 , Essen, Germany.
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