RESUMEN
A case of a rapidly progressing giant cell tumor of the middle phalanx is presented. The patient underwent en bloc resection with iliac crest grafting and distal interphalangeal fusion. Surgical technique and patient's functional outcomes are described.
Asunto(s)
Neoplasias Óseas , Trasplante Óseo , Falanges de los Dedos de la Mano , Tumor Óseo de Células Gigantes , Ilion , Humanos , Ilion/trasplante , Tumor Óseo de Células Gigantes/cirugía , Neoplasias Óseas/cirugía , Falanges de los Dedos de la Mano/cirugía , Trasplante Óseo/métodos , Masculino , Artrodesis , Adulto , FemeninoRESUMEN
This report emphasizes careful consideration of surgical technique for intramedullary screw fixation in middle phalanx fractures. Highlighting pitfalls, particularly with K-wire placement, it suggests the antegrade trans-articular approach as superior, urging further research for improved patient outcomes.
Asunto(s)
Tornillos Óseos , Falanges de los Dedos de la Mano , Fijación Intramedular de Fracturas , Fracturas Óseas , Humanos , Falanges de los Dedos de la Mano/cirugía , Falanges de los Dedos de la Mano/lesiones , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fracturas Óseas/cirugía , Hilos OrtopédicosRESUMEN
Objective: To explore the mechanism, surgical method, and effectiveness of proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of the flexor digitorum tendon. Methods: A retrospective analysis was conducted on the clinical data of 4 patients with proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of flexor digitorum tendon admitted between May 2018 and September 2022. The patients were all male, the age ranged from 26 to 52 years, with an average of 33 years. The injured fingers included 1 case of middle finger and 3 cases of ring finger. The causes of injury were rock climbing of 2 cases and carrying heavy objects of 2 cases. Preoperative anteroposterior and lateral X-ray films and CT examination of the fingers showed a lateral avulsion fracture of the proximal phalanx, with a fracture block length of 15-22 mm and a width of 3-5 mm. The total active range of motion (TAM) of the injured finger before operation was (148.75±10.11)°. The grip strength of the middle and ring fingers was (15.50±2.88) kg, which was significantly lower than that of the healthy side (50.50±7.93) kg ( t=-8.280, P<0.001). The time from injury to operation was 2-7 days, with an average of 3.5 days. One Kirschner wire with a diameter of 1.0 mm was used for direct fixation through the fracture block, while two Kirschner wires with a diameter of 1.0 mm were used for compression fixation against the fracture block. The fracture healing was observed, and the TAM of the injured finger and the grip strength of the middle and ring fingers were measured. The finger function was evaluated according to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society. Results: The incisions all healed by first intention after operation. All patients were followed up 6-28 months, with an average of 19 months. X-ray films showed that all avulsion fractures of proximal phalanx reached bony union, and the healing time ranged from 4 to 8 weeks, with an average of 4.6 weeks. At last follow-up, the grip strength of the middle and ring fingers was (50.50±7.76) kg, which significantly improved when compared with preoperative one ( t=-8.440, P<0.001). The TAM of the injured finger reached (265.50±2.08)°, and there was a significant difference when compared with preoperative one ( t=-21.235, P<0.001). According to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society, the finger function was all evaluated as excellent in 4 cases. Conclusion: Using Kirschner wire fixation through bone blocks and external compression fixation of bone blocks for treating proximal phalangeal bone avulsion fracture caused by A2 circular trochlear injury of the flexor digitorum tendon can achieve good effectiveness.
Asunto(s)
Hilos Ortopédicos , Traumatismos de los Dedos , Falanges de los Dedos de la Mano , Fijación Interna de Fracturas , Fracturas por Avulsión , Traumatismos de los Tendones , Humanos , Masculino , Adulto , Fijación Interna de Fracturas/métodos , Fracturas por Avulsión/cirugía , Falanges de los Dedos de la Mano/lesiones , Falanges de los Dedos de la Mano/cirugía , Persona de Mediana Edad , Traumatismos de los Tendones/cirugía , Traumatismos de los Dedos/cirugía , Fuerza de la Mano , Resultado del Tratamiento , Rango del Movimiento Articular , Fracturas Óseas/cirugíaRESUMEN
BACKGROUND: Bony defects in finger injuries and infections impose high demands on their treatment due to the close anatomic relationships. Ideally, the injuries are entirely treated in emergency care. Due to the mechanism of the accident, contaminated and compromised soft tissues are often present and set limits to single-stage treatment. We present the long-term subjective and functional results after two-stage reconstruction of bony finger joint defect injuries. PATIENTS AND METHODS: Over a period of 15 years, a total of 40 patients with 43 fingers were treated due to a defect injury in the phalanges. Initially, the finger was stabilised with Kirschner wires after debridement. After consolidation of the soft tissue, the bone was reconstructed in a subsequent operation by interposition of an iliac crest graft. Complications occurred in 9 patients. Twenty-five patients with 27 fingers were followed up for 10.3 years. Range of motion, length of the affected finger, and grip force, each in relation to the contralateral extremity, were recorded. In addition to a subjective assessment of the global result, the daily function was determined by means of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Significant differences compared with the contralateral extremity (p<0.05) were found in length (70 mm; 91.0%) and total mobility of the affected finger (95°; 46.0%), hand span when the thumb was involved (202.5 mm; 93.4%), and power grip when one of the fingers was injured (30 kg; 84.1%). The DASH score was 4.2 points (0-55.8). Subjectively, 88% of patients were satisfied with the treatment outcome. CONCLUSION: In case of contaminated and compromised soft tissues, the two-stage treatment of bony defect injuries in finger joints by arthrodesis of the joint is a reliable treatment strategy. In the long run, it results in a very satisfactory function of the hand in everyday life although significant differences have been measured compared with the contralateral extremity.
Asunto(s)
Hilos Ortopédicos , Desbridamiento , Traumatismos de los Dedos , Articulaciones de los Dedos , Complicaciones Posoperatorias , Rango del Movimiento Articular , Humanos , Masculino , Femenino , Adulto , Traumatismos de los Dedos/cirugía , Persona de Mediana Edad , Articulaciones de los Dedos/cirugía , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Rango del Movimiento Articular/fisiología , Estudios de Seguimiento , Adulto Joven , Trasplante Óseo/métodos , Adolescente , Falanges de los Dedos de la Mano/cirugía , Falanges de los Dedos de la Mano/lesiones , Fuerza de la Mano , Ilion/trasplante , Reoperación , Procedimientos de Cirugía Plástica/métodos , Anciano , Satisfacción del PacienteRESUMEN
OBJECTIVES: This study aims to present long-term follow-up results of the reverse dorsolateral proximal phalangeal island flap designed for reconstruction of large fingertip and pulp defects. METHODS: We examined 18 patients who underwent reverse dorsolateral proximal phalangeal island flap surgery to address ≥2.5 cm fingertip and pulp defects. Mean follow-up was 84.4 months. Sensitivity assessments were conducted using the Semmes-Weinstein monofilament and 2-point discrimination tests. Additionally, we evaluated finger joint active range of motion, complications and cold intolerance. RESULTS: Mild venous congestion was observed in 5 flaps. Significant differences were observed in 2-point discrimination and Semmes-Weinstein monofilament tests between the injured and contralateral sides, specifically in the flaps, the dorsal side of the middle phalanx, and the donor site. The flap's mean static 2-point discrimination was 8.3 mm. Restricted distal interphalangeal joint extension was observed in 2 cases. Total active motion with the flap was good or excellent in the injured fingers, but with a significant difference between injured and contralateral fingers. Additionally, 42% of the injured fingers exhibited hook nail deformity, and 2 patients reported cold intolerance. Despite these issues, most patients has high scores for the appearance and satisfaction aspects of the Michigan Hand Outcomes Questionnaire. CONCLUSION: In moderate or larger fingertip defects, the reverse dorsolateral proximal phalangeal island flap serves as an alternative for reconstructing both fingertip and pulp issues. However, this option involves sacrificing some sensation in the dorsum of the middle phalangeal finger and the donor area. LEVEL OF EVIDENCE: IV, therapeutic study.
Asunto(s)
Traumatismos de los Dedos , Rango del Movimiento Articular , Colgajos Quirúrgicos , Humanos , Masculino , Traumatismos de los Dedos/cirugía , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Estudios de Seguimiento , Falanges de los Dedos de la Mano/cirugía , Falanges de los Dedos de la Mano/lesiones , AdolescenteRESUMEN
A 32 year-old climber sustained a grade IV frostbite injury to the right hand which required amputation at the neck of the proximal phalanges of all the long fingers. To increase range of motion and strength in the remaining metacarpophalangeal joints, tenodesis of the flexor digitalis superficialis and profundus tendons onto the proximal phalanges was performed. Several revisions for removal of bony spurs, dorsal skin advancement flaps and web space deepening were necessary. After 2 years, the patient achieved 10-0-100° metacarpophalangeal joint range of motion in extension-flexion and could do full body-weight pull-ups on 1 cm deep holds, lift 50 kg on a 2 cm deep hold (normal contralateral side, 40 kg), climb up to F7a routes and use a mechanical 4-finger functional prosthesis.
Asunto(s)
Traumatismos de los Dedos , Congelación de Extremidades , Montañismo , Tenodesis , Humanos , Congelación de Extremidades/cirugía , Adulto , Masculino , Traumatismos de los Dedos/cirugía , Rango del Movimiento Articular , Falanges de los Dedos de la Mano/cirugía , Falanges de los Dedos de la Mano/lesionesRESUMEN
PURPOSE: To compare the outcomes of type II pediatric phalangeal neck fractures (PPNFs) treated with closed reduction and cast immobilization (CRCI) versus closed reduction percutaneous pinning (CRPP), and evaluated the clinical efficacy of conservative versus surgical treatment of type II PPNFs via meta-analysis. METHODS: Patients aged ≤ 14 years with type II PPNFs were divided into conservative (CRCI) and operative (CRPP) groups. Radiographs measured angulation and translation; hand function was assessed with total active range of motion (TAM) and Quick-DASH. Complication rates were also compared between the groups. A meta-analysis of conservative versus operative treatment confirmed the clinical results. Statistical analysis was performed using SPSS 26.0 and R studio 3.0 with two-tailed, chi-squared, and Mann-Whitney U or t-tests, P < 0.05. Meta-analysis used fixed or random effects models, calculating mean differences and odds ratios for outcomes, and assessing heterogeneity with I2 and Q tests. RESULTS: Final angulation (3.4° ± 3.7° and 4.9° ± 5.4° vs. 3.6° ± 3.7° and 4.2° ± 4.3°) and displacement (6.3% ± 5.8% and 5.7% ± 4.7% vs. 5.8% ± 5.5% and 3.2% ± 4.2%) in the coronal and sagittal planes were not different statistically between the conservative and surgical groups (P > 0.05), but improved significantly compared to preoperative values (P < 0.05). Although Quick-DASH scores were comparable in both groups (P = 0.105), conservatively treated patients had a significantly better TAM at the last follow-up visit (P = 0.005). The complication rates were 24.2% and 41.7% in the surgical and conservatively treated groups respectively (P = 0.162). However, the latter primarily experienced imaging-related complications, whereas the former experienced functional complications (P = 0.046). Our meta-analysis (n = 181 patients) also showed comparable functional (P = 0.49) and radiographic (P = 0.59) outcomes and complication rates (P = 0.21) between the surgical (94 patients) and conservative (87 patients) groups. CONCLUSIONS: Conservative and surgical treatments are both reliable and safe approaches for managing type II PPNF in children. However, conservatively treated patients generally experience similar radiographic outcomes, lower complication rates, and better functional outcomes than surgically treated ones.
Asunto(s)
Hilos Ortopédicos , Moldes Quirúrgicos , Falanges de los Dedos de la Mano , Humanos , Niño , Falanges de los Dedos de la Mano/lesiones , Falanges de los Dedos de la Mano/cirugía , Masculino , Femenino , Adolescente , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/efectos adversos , Resultado del Tratamiento , Fracturas Óseas/cirugía , Rango del Movimiento Articular , PreescolarRESUMEN
Congenital dorsal curvature of the distal phalanx has been previously described as 'reverse Kirner' or 'ski-jump' deformity. This report describes bilateral occurrence in the thumbs. A 13-year-old male presented with difficulty caring for his thumbnails and in picking up small objects. Examination showed dorsal curvature of the distal phalanges of both thumbs, with greater curvature of the right side. Radiographs showed wedge-shaped epiphyses and dorsal curvature without coronal plane deviation of the distal phalanges. There was objective and subjective decrease in function associated with lateral pinch and tripod grasp. The reported aetiopathogenesis for Kirner deformity cannot explain the observed dorsal curvature. The bilateral nature makes a secondary physeal cause unlikely and suggests an embryologic basis. Due to the noticeable deficits in function, operative intervention may be warranted. Level of Evidence: Level V (Therapeutic).
Asunto(s)
Falanges de los Dedos de la Mano , Deformidades Congénitas de la Mano , Masculino , Humanos , Adolescente , Pulgar/cirugía , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/cirugía , Deformidades Congénitas de la Mano/cirugía , RadiografíaRESUMEN
INTRODUCTION: Phalangeal fractures are the most common fractures of the hand and in particular the proximal phalanx of the long fingers is the most involved. These fractures can ben conservatively managed but, when the fracture pattern is considered unstable, surgical treatment is recommended. However, there is no consensus in literature about the proper surgical option for extra-articular proximal phalanx fractures. MATERIAL AND METHODS: We compared clinical and radiographical results after treatment of 75 cases of extra-articular proximal phalanx fractures using three different surgical techniques: closed reduction and internal fixation (CRIF) with Kirschner wires (G1 group), open reduction internal fixation (ORIF) with plates and screws or lag screws (G2 group), and closed reduction and intramedullary screw fixation (CRIMEF)(G3 group). RESULTS: We found no significant differences in term of union rate and time to fracture healing between the three groups. However, we found a significant reduction in time to return at work and in TAM at the final follow-up examination in G3 group (treated with CRIMEF) when compared with both G1 and G2. No differences in complications rate were found between three groups. DISCUSSION: The surgical variability in the management of extra-articular phalanx fractures create lacks on standard guide for treatment. CONCLUSIONS: In conclusion, our results showed good clinical and radiographical results with all the three surgical options. However, the closed reduction and internal fixation with intramedullary screws (CRIMEF) seems to be better in terms of time to return to work and TAM at the final follow-up, probably due to good primary stability and little risk of soft tissue adherence development.
Asunto(s)
Falanges de los Dedos de la Mano , Fracturas Óseas , Humanos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Fijación Interna de Fracturas/métodos , Tornillos Óseos , Hilos Ortopédicos , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/cirugía , ManoAsunto(s)
Hilos Ortopédicos , Condroma , Falanges de los Dedos de la Mano , Fracturas Espontáneas , Humanos , Falanges de los Dedos de la Mano/lesiones , Falanges de los Dedos de la Mano/cirugía , Condroma/cirugía , Condroma/diagnóstico por imagen , Fracturas Espontáneas/cirugía , Fracturas Espontáneas/etiología , Fracturas Espontáneas/diagnóstico por imagen , Fijadores Externos , Neoplasias Óseas/cirugía , Fijación de Fractura/instrumentaciónRESUMEN
Intramedullary fixation has long been popular for fracture fixation in the upper extremity from the shoulder through the carpus. Recently, intramedullary fixation in the hand has gained increasing interest, specifically in the metacarpals and phalanges, corresponding with the development of improved cannulated headless screw technology. Along with the advantages of increased operative speed and less surgical dissection, which can promote rapid healing, many benefits exist, supporting their use despite some drawbacks. This article reviews the background and biomechanics of intramedullary fixation with a specific focus on cannulated headless screws, describes the application and techniques of intramedullary screw fixation in the hand, and details the associated outcomes and costs for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis.
Asunto(s)
Falanges de los Dedos de la Mano , Fracturas Óseas , Traumatismos de la Mano , Huesos del Metacarpo , Humanos , Fracturas Óseas/cirugía , Fijación Interna de Fracturas/métodos , Mano , Falanges de los Dedos de la Mano/cirugía , Huesos del Metacarpo/cirugía , Huesos del Metacarpo/lesiones , ArtrodesisRESUMEN
Phalangeal fractures are extremely common in the pediatric and adolescent populations. The incidence of phalangeal fractures peaks in children ages 10 to 14 years, corresponding to the age in which children begin contact sports. Younger children are more likely to experience crush injuries, whereas older children often sustain phalangeal fractures during sports. The physis is particularly susceptible to fracture because of the biomechanically weak nature of the physis compared with the surrounding ligaments and bone. Phalangeal fractures are identified through a thorough physical examination and are subsequently confirmed with radiographic evaluation. Management of pediatric phalangeal fractures is dependent on the age of the child, the severity of the injury, and the degree of fracture displacement. Nondisplaced fractures are often managed nonsurgically with immobilization, whereas unstable, displaced fractures may require surgery, which is often a closed rather than open reduction and percutaneous pinning.
Asunto(s)
Traumatismos de los Dedos , Falanges de los Dedos de la Mano , Fijación Intramedular de Fracturas , Fracturas Óseas , Deportes , Adolescente , Niño , Humanos , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/lesiones , Falanges de los Dedos de la Mano/cirugía , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugíaRESUMEN
Brachytelephalangy is a congenital condition characterised by the shortening of the distal phalanges, which affects appearance but does not cause severe functional disability. Therefore, most hand surgeons do not consider it to require surgical treatment, and there are limited options to improve the appearance of the affected digits. We present the case of a 55-year-old male patient with congenital brachytelephalangy of the thumb, who underwent a bone lengthening procedure using distraction osteogenesis with the Ilizarov minifixator. The distal phalanx was carefully osteotomised and gradually lengthened up to 5 mm with no adverse events observed. The patient was satisfied with the natural appearance of his thumb after the surgery. This gradual callus distraction method is a radical solution for people with brachytelephalangy, particularly after epiphyseal closure and can manage the external fixator on their own. Level of Evidence: Level V (Therapeutic).
Asunto(s)
Falanges de los Dedos de la Mano , Osteogénesis por Distracción , Masculino , Humanos , Persona de Mediana Edad , Osteogénesis por Distracción/métodos , Pulgar/cirugía , Fijadores Externos , Falanges de los Dedos de la Mano/cirugía , OsteogénesisRESUMEN
Fractures of the phalanges encompass a wide range of injury patterns with variable articular and soft tissue involvement. The goals of treatment whether conservative or surgical are the restoration of function while limiting the risk of complications. An armamentarium of fixation options allows the surgeon to appropriately treat these fractures with the intention of initiating early postoperative mobilization. Previous publications report variable rates of complications following internal fixation of phalangeal fractures which represents an unsolved problem. It is incumbent on the surgeon to utilize meticulous surgical technique, achieve anatomic reduction with stable fixation and initiate early postoperative mobilization where indicated. In the following text, we review the management of most types of phalangeal fractures, except fracture-dislocations of the proximal interphalangeal joint. These injuries comprise a wide spectrum of presentation; thus, an understanding of anatomical and mechanical principles is integral to achieving a successful outcome.
Asunto(s)
Falanges de los Dedos de la Mano , Fractura-Luxación , Fracturas Óseas , Humanos , Fracturas Óseas/cirugía , Extremidades , Falanges de los Dedos de la Mano/cirugía , ArticulacionesRESUMEN
Reconstruction of osseous defects of the distal phalanx of the thumb is usually addressed with free bone grafts or free vascularized bone flaps. Some reports demonstrated the possibility to harvest an osteo-cutaneous flap in the dorso-ulnar side of the first metacarpal bone with success. In the same manner, no reports are present in the literature in which bone deficits were reconstructed with this flap elevated as an exclusively osseous flap. We report our successful experience with one case of distal phalanx reconstruction of the thumb by mean of the dorso-ulnar reverse flow pedicled osseous flap. The patient was a 45-year-old woman with symptoms related to a cystic bone tumor that involved the entirety of the distal phalanx of the thumb. Flap dimensions were calculated based on x-ray gap measures, which resulted in need of 1.5 × 0.8 × 0.5 cm flap dimensions. An osseous flap was harvested and transposed from the ulnar side of the first metacarpal bone. K-wire fixation was utilized for bone flap stabilization. No complications occurred and excellent functional result was evaluated at 6 months follow-up. In our opinion, the flap may be considered as an alternative to free bone grafts in situations in which perilesional tissues may jeopardize the process of free graft taking and in cases in which free vascularized bone flaps are not feasible for patient or surgeon decision.
Asunto(s)
Falanges de los Dedos de la Mano , Procedimientos de Cirugía Plástica , Femenino , Humanos , Persona de Mediana Edad , Pulgar/cirugía , Colgajos Quirúrgicos/cirugía , Falanges de los Dedos de la Mano/cirugía , Trasplante ÓseoRESUMEN
Phalangeal and metacarpal fractures that require operative treatment have documented complications in around 50% of patients. The most common of these complications are stiffness and malunion. These can be highly challenging problems for the hand surgeon. In this article, we discuss complications after phalangeal and metacarpal fractures and treatment strategies for these complications.
Asunto(s)
Falanges de los Dedos de la Mano , Fracturas Óseas , Traumatismos de la Mano , Huesos del Metacarpo , Humanos , Huesos del Metacarpo/cirugía , Huesos del Metacarpo/lesiones , Fracturas Óseas/cirugía , Traumatismos de la Mano/cirugía , Fijación Interna de Fracturas , Falanges de los Dedos de la Mano/cirugía , Falanges de los Dedos de la Mano/lesionesRESUMEN
Avulsion of the flexor digitorum profundus, usually known as jersey or rugby finger, is a rare condition that can only be treated surgically. It is mostly reported in sports injuries, in which the diagnosis is easily made. It is less frequent in household accidents, but should not be ignored because good results are time-dependent. Type IV jersey finger is the combination a fracture of the volar base of the distal phalanx and avulsion of the flexor digitorum profundus. This is a rare variety, and the surgical approach has not been discussed in detail. We introduce here a case report describing the clinical aspect, diagnostic approach, surgical technique and results at 6 months.
Asunto(s)
Traumatismos de los Dedos , Falanges de los Dedos de la Mano , Fracturas Óseas , Traumatismos de los Tendones , Humanos , Traumatismos de los Tendones/cirugía , Fracturas Óseas/cirugía , Dedos , Traumatismos de los Dedos/diagnóstico por imagen , Traumatismos de los Dedos/cirugía , Traumatismos de los Dedos/complicaciones , Falanges de los Dedos de la Mano/cirugíaRESUMEN
Posttraumatic malunion with combination of angular, rotational, and shortening deformity of the proximal phalanx may cause scissoring of a finger and impairment of hand function. Cosmetic disfigurement and severe dysfunction of fingers require surgical correction, most often via open corrective osteotomies and rigid fixation with a plate or screws. However, such an approach requires a longer incision, inevitably results in a scar, and has a higher potential for extensor tendon adhesion. Also, abruption of the periosteum and plating of the phalange requires longer bone healing time. Thus, we devised a technique of minimally invasive correction of phalangeal malunion using an external mini-fixator. We presented representative three cases of malunited fractures of phalanges treated with the Ilizarov mini-fixator in adolescence and review reports of similar cases. The usage of Ilizarov mini-fixator provided excellent outcomes for posttraumatic malunion of three fingers.
Asunto(s)
Falanges de los Dedos de la Mano , Fracturas Mal Unidas , Humanos , Adolescente , Fracturas Mal Unidas/diagnóstico por imagen , Fracturas Mal Unidas/cirugía , Fijación Interna de Fracturas , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/cirugía , Osteotomía/métodos , DedosRESUMEN
Hand fractures represent commonly encountered injuries in pediatric patients. However, due to modern means of mobility and product safety, the occurrence and distribution of these fractures have changed during the last decades. Therefore, it was the aim of this study to present an update of the epidemiology, pattern, and treatment of hand fractures in a large pediatric cohort. All patients aged between 0 and 17 years treated in our Department in 2019 with fractures of the phalanges, metacarpus, or carpus were included. The medical records were reviewed for age, gender, injury mechanism, fracture localization, season, and treatment. Patients were divided into three different age groups (0-5, 6-12, and 13-17 years). A total of 731 patients with 761 hand fractures were treated during the 1-year study period. The mean age was 11.1 ± 3.5 years, and the majority was male (65%). Male patients were significantly older compared to female patients (p = 0.008). Also, 78.7% of the fractures affected the phalanges, 17.6% the metacarpals, and 3.7% the carpal bones. The proximal phalanges were the most commonly fractured bones (41.5%). Patients with fractures of the carpus were significantly older compared to children sustaining fractures of the metacarpus or phalangeal bones (p < 0.001). Sixteen percent of our patients were treated surgically; these patients were significantly older compared to conservatively treated patients (p = 0.011). Conclusion: The epidemiology, mechanisms of injury, distribution, and treatment of hand fractures significantly varies among different age groups. This knowledge is of importance for educational purposes of younger colleagues entrusted with care of children and adolescents as well as development of effective prevention strategies. What is Known: ⢠Pediatric hand fractures represent the second most common fractures in children. ⢠The epidemiology of pediatric hand fractures has changed during the last decades and therefore there is a need for an update regarding distribution and epidemiology of pediatric hand fractures. What is New: ⢠In this retrospective cohort study, 761 pediatric hand fractures of 731 patients were analyzed in detail. ⢠The main mechanisms of younger patients were entrapment injuries, older children most commonly sustained their fractures due to ball sport injuries. There was an increasing rate of metacarpal and carpal fractures with increasing age, and these fractures had to be treated operatively more often than phalangeal fractures.
Asunto(s)
Falanges de los Dedos de la Mano , Fracturas Óseas , Traumatismos de la Mano , Huesos del Metacarpo , Niño , Humanos , Masculino , Adolescente , Femenino , Recién Nacido , Lactante , Preescolar , Estudios Retrospectivos , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Fracturas Óseas/terapia , Huesos del Metacarpo/lesiones , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/lesiones , Falanges de los Dedos de la Mano/cirugía , Traumatismos de la Mano/epidemiología , Traumatismos de la Mano/etiología , Traumatismos de la Mano/terapiaRESUMEN
BACKGROUND: Treatment protocols for macrodactyly have not been elucidated due to its rarity and variety of clinical manifestations. This study aims to share our long-term clinical results of epiphysiodesis in children with macrodactyly. METHODS: A retrospective chart review was performed for 17 patients with isolated macrodactyly treated with epiphysiodesis over 20 years. Length and width of each phalanx in both the affected finger and the corresponding unaffected finger in the contralateral hand were measured. Results were presented in ratios of the affected to unaffected side for each phalanx. Measuring of length and width of phalanx was performed preoperatively and postoperatively at 6, 12, and 24 months, and the last follow-up session. Postoperative satisfaction scoring was done with visual analogue scale. RESULTS: The mean follow-up period was 7 years and 2 months. In the proximal phalanx, length ratio significantly decreased compared with preoperative state at after more than 24 months, in the middle phalanx after 6 months, in the distal phalanx after 12 months. When classified by the growth patterns, the progressive type showed significant decrease in length ratio at after 6 months, and the static type after 12 months. Patients were overall satisfied with the results. CONCLUSION: Epiphysiodesis effectively regulated longitudinal growth with different degree of control for different phalanges in the long-term follow-up.