Boyer Jeffrey S, London Daniel A, Stepan Jeffrey G, Goldfarb Charles A
Department of Orthopaedic Surgery, St Louis Childrens Hospital, Washington University School of Medicine, St Louis, MO.
J Pediatr Orthop. 2015 Apr-May;35(3):219-23. doi: 10.1097/BPO.0000000000000253.
The outcomes literature on proximal phalanx fractures in children is sparse. The purpose of this study is to report the complications and outcomes of displaced proximal phalanx fractures after treatment with closed reduction and percutaneous pinning (CRPP).
A retrospective chart review identified 105 patients treated with CRPP of displaced proximal phalanx fractures. Specific complications were recorded for all patients. Thirty-one of these patients returned >1 year after surgery for assessment including visual analogue scales (VAS) of pain level, functional ability, and esthetics. Objective measurements included range of motion, grip and pinch strength, and finger deformity. Radiographs were taken to assess deformity.
Five of the 105 patients (4.8%) had a complication including infection, pin site complication, or malunion. Of the entire group, 36 had stiffness and 31 ultimately underwent hand therapy to regain motion. Subcondylar fractures were associated with a greater likelihood of stiffness. In the 31 patients returning for assessment, the median VAS score was 0 for pain (none), function (full), and esthetics (perfect). Range of motion, grip, and pinch strength were equivalent to the contralateral side. Seven of the 31 patients (22.6%) had a measureable coronal plane deviation averaging 5 degrees (range, 3 to 13 degrees) on radiographs. Deviation was associated with subcondylar fractures and a worse esthetic VAS. Deviation was not associated with worse outcomes overall.
Pediatric patients with a displaced proximal phalanx fracture treated with CRPP have an initial notable complication rate related to stiffness; subcondylar proximal phalanx fractures are more commonly affected. At >1-year follow-up, patients had full motion, no pain, and were happy with both function and appearance despite minor deformity in some. These complication data may help better inform patients and families before surgical intervention.
Level IV-therapeutic.
关于儿童近节指骨骨折的预后文献较少。本研究的目的是报告闭合复位经皮穿针固定（CRPP）治疗移位近节指骨骨折后的并发症及预后。
一项回顾性图表审查确定了105例接受CRPP治疗移位近节指骨骨折的患者。记录所有患者的具体并发症。其中31例患者术后1年以上返回进行评估，包括疼痛程度、功能能力和美观的视觉模拟量表（VAS）。客观测量包括活动范围、握力和捏力以及手指畸形。拍摄X线片以评估畸形情况。
105例患者中有5例（4.8%）出现并发症，包括感染、针道并发症或骨不连。在整个组中，36例出现僵硬，31例最终接受手部治疗以恢复活动。髁下骨折与僵硬的可能性更大相关。在返回进行评估的31例患者中，疼痛（无）、功能（完全）和美观（完美）的VAS评分中位数均为0。活动范围、握力和捏力与对侧相当。31例患者中有7例（22.6%）在X线片上有可测量的冠状面偏差，平均为5度（范围为3至13度）。偏差与髁下骨折和较差的美观VAS相关。偏差总体上与较差的预后无关。
采用CRPP治疗的移位近节指骨骨折的儿科患者最初有与僵硬相关的显著并发症发生率；髁下近节指骨骨折更常受影响。在1年以上的随访中，尽管有些患者有轻微畸形，但患者活动完全、无疼痛，对功能和外观都很满意。这些并发症数据可能有助于在手术干预前更好地告知患者及其家属。
四级治疗性。
