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CC BY-NC-ND 4.0 · J Hand Microsurg 2023; 15(02): 124-132
DOI: 10.1055/s-0041-1730885
Original Article

Phalangeal and Metacarpal Fractures in Children: A 10-Year Comparison of Factors Affecting Functional Outcomes in 313 Patients

Ailbhe L. Kiely 
1   Department of Plastic & Reconstructive Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, United Kingdom
,
Michelle Griffin
2   Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, United Kingdom
,
Faith Hyun Kyung Jeon
2   Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, United Kingdom
,
Grant S. Nolan
3   Whiston Hospital, Warrington Road, Prescot, Merseyside, United Kingdom
,
Peter E. Butler
2   Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, United Kingdom
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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.

Keywords

hand surgery - pediatric - metacarpal - phalangeal - proximal phalanx - middle phalanx


Publikationsverlauf

Artikel online veröffentlicht:
19. Juni 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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