Early Surgical Results of Pediatric Unicondylar Phalangeal Fractures.

Abstract

Purpose: Conventional teaching dictates that timely diagnosis and expeditious treatment of unicondylar phalangeal fractures are essential to restore articular congruity, which allows for optimal range of motion and function. The objective of this study was to compare the radiographic and clinical results of surgical treatment of acute and chronic unicondylar phalanx fractures in pediatric patients.

Methods: Thirty-four patients with unicondylar phalangeal fractures underwent surgical intervention at a pediatric tertiary care center from 2004 to 2016. A fracture was defined as acute if an interval of 4 weeks or less had elapsed between the date of injury and date of surgery and chronic if an interval of more than 4 weeks had elapsed between the date of injury and date of surgery. Preoperative and postoperative radiographs were assessed. The joint alignment was determined by measuring the angle between the longitudinal axis of the phalanx and a line tangential to the articular condyles on anteroposterior radiographs.

Results: There were 24 patients (71%) with acute and 10 (29%) with chronic fractures. An oblique volar fracture pattern was most common in both the groups. The average joint alignment obtained from the anteroposterior radiographs at presentation was 6° in the acute group and 12° in the chronic group. The surgical procedures performed included closed reduction and percutaneous pinning, open reduction and internal fixation, osteoclasis or osteotomy and fixation, and corrective advancement osteotomy. The posttreatment alignment was within 3° of neutral in 21 patients (88%) with acute injury and 8 (80%) with chronic injury. The average interphalangeal joint range of motion at the final clinic visit was 1°-92° in the acute group and 4°-85° in the chronic group. One patient with chronic injury developed avascular necrosis after treatment with corrective osteotomy.

Conclusions: The patterns and characteristics of unicondylar phalanx fractures are similar between pediatric patients and adults. The radiographic alignment and digital motion are improved with surgical reduction and fixation, regardless of chronicity.

Type of study/level of evidence: Therapeutic IV.