Juxta-Epiphyseal Fractures of the Base of the Proximal Phalanx of the Fingers in Children and Adolescents

Abstract

A series of 34 juxta-epiphyseal fractures of the base of the proximal phalanx of the fingers of children and adolescents are presented. The pattern of injury appeared identical in all these fractures, with a lateral angulation force separating a small triangular metaphyseal fragment from the base of the phalanx on the side of angulation and the fracture line then continuing through the metaphysis, 1–2mm distal to the growth plate. Fractures were classified into two types according to the degree of displacement. Type 1 fractures ( n=18) were mildly displaced and were all successfully treated with closed reduction and splinting. Type 2 fractures ( n=16) were severely displaced and problems with obtaining an adequate reduction and long-term residual deformities were encountered. One patient with a severely displaced fracture required open reduction and Kirschner-wire fixation because of flexor tendon entrapment at the fracture site. Another five cases required Kirschner-wire fixation after closed manipulation in order to maintain the reduction. The remaining 10 patients with Type 2 fractures were treated by closed reduction and splinting, and two patients healed with malunion causing a “pseudo-claw” deformity.