Treatment of fractures of the main phalanx of the fingers in children

BACKGROUND: Fractures of the bones of the hand and wrist account for 25% of all fractures in children, whereas the phalanges are the most common localization of these injuries and account for 15%–30% of all fractures of the upper limb. To fix fractures of the neck of the middle and main phalanx of the fingers, traumatologists resort to retrograde osteosynthesis with a spoke, which in all cases passes through the articular surface of the distal fragment, thereby blocking the joint adjacent to the fracture. This significantly complicated postoperative rehabilitation to restore movements.

AIM: This study aimed to comparatively analyze the results of extra-articular osteosynthesis of fractures of the distal metaphysis of the main phalanx of children’s fingers.

MATERIALS AND METHODS: A prospective cohort study included 52 children with fractures of the main phalanx of the fingers. The study cohort of children was divided into two groups. The main group included 29 children who underwent osteosynthesis of the distal fragment of the phalanx with spokes according to the author’s method without passing them through the distal or proximal interphalangeal joint. The comparison group included 23 children who, during osteosynthesis, had spokes carried out retrogradely, through the articular surface of the distal phalanx fragment. The total volume of the restored active movements in the proximal interphalangeal joint was compared after 3, 6, and 12 weeks from the moment of surgery, including local signs of inflammation in the needle insertion site after 3 and 7 days from the moment of surgery.

RESULTS: In the main group, signs of inflammation were found only in 10% of the cases, whereas in the comparison group, more serious signs were observed, such as the release of exudate along the spokes in two cases on day 3. The average values of the amplitude of movements at week 3 in the main group are more than two times higher than the average values of the comparison group, 12.06° and 5.56°, respectively. The volume of movements in the main group was restored more than two times more efficiently, and in several patients, by week 12, it was restored to 100° of the total volume of active movements in the joint (p < 0.05).

CONCLUSIONS: The author’s method of extra-articular and antegrade osteosynthesis of the fractures of the neck of the main phalanges in children made it possible to achieve better functional results in comparison with the standard method.