Fractures of the base of the proximal phalanx in children: comparison between cast immobilization and Kirschner wire fixation.

Abstract

To retrospectively evaluate the clinical and radiographic outcomes of fractures of the base of the proximal phalanx (FBPP) in children by closed reduction and cast immobilization (CRCI) and closed reduction and percutaneous pinning (CRPP). Thirty-four consecutive children with FBPP were treated by CRCI (group A) and CRPP (group B). The diaphyseal axis-metacarpal head angle (DHA) was measured in anteroposterior radiographs before and after treatment. At the last follow-up visit, the range of motion of the injured finger was evaluated by the Total Active Flexion Scale. One year and more after the index procedure, patients were asked to answer the Michigan Hand Outcomes Questionnaire (MHQ). Fifteen patients (44.1%) were in group A and 19 (55.9%) in group B. groups A and B did not differ significantly in their demographics and preoperative DHA (P > 0.05). However, the postoperative DHA improved significantly after treatment, whether group A (P < 0.001) or group B (P < 0.001). And nonoperative treatment yielded a better DHA than surgical treatment (P = 0.01). Overall, five in group A (20%) and two in group B (37%) (P = 0.06) developed a complication. The mean MHQ score was 97.2 ± 5.3 (range, 78.1-100) and 99.3 ± 2.0 (range, 92.8-100) in groups A and B, respectively (P = 0.15). Children with isolated, displaced FBPP treated conservatively can achieve similar clinical and radiological outcomes, and lower complication rates, compared to patients managed surgically; however, fracture more severely displaced initially may have higher rates of complications after surgical fixation. If conservative treatment fails, surgery is recommended.