[A new technique of intrafocal pinning for phalangeal neck fractures in children].

INTRODUCTION

Phalangeal neck fractures are unusual, occurring mainly in children. This study aims at assessing the results of treatment of this type of fracture and presents a new technique for displaced fractures namely intrafocal pinning.

PATIENTS AND METHODS

From January 2001 to January 2007, we treated 49 children (32 boys and 17 girls) with 52 phalangeal neck fractures. The patients were aged between three months and 14 years (average seven years). Five fractures were open but without nerve, artery or tendon damage. The 32 undisplaced or minimally displaced fractures were treated by closed methods. Thirteen displaced fractures (of which three were secondary displacements) were treated with an intrafocal pinning technique inspired by the Kapandji technique for distal radius fractures. Seven fractures (five open and two closed but displaced) were treated using standard osteosynthesis techniques (temporary arthrodesis, crossed K wires or cerclage).

RESULTS

We reviewed the patients an average of 18 months later. We classified the results according to Barton's classification: excellent, good, fair and bad. Among the 13 fractures treated with an intrafocal pinning technique, 11 gave excellent results and two gave good results. We did not find any infection, tendon rupture, phalangeal head osteonecrosis or nonunion. We had to reoperate on one proximal phalanx thumb fracture because of delayed consolidation.

DISCUSSION

Percutaneous reduction of the displacement and pinning seems to give the best results for the treatment of displaced fractures. The surgeon aims at getting the best anatomical result whilst limiting soft tissue damage. The proposed technique seems to give good results as it allows a percutaneous reduction of the displacement and an effective means of holding the reduction. Open fractures have a poorer prognosis.