Nonunion without avascular necrosis of finger phalangeal neck fractures in children: report of 4 cases.

Nonunion without avascular necrosis of finger phalangeal neck fractures in children is rare. A cohort of all pediatric phalangeal neck fractures of the fingers over a 4-year period (2010-2013) revealed 89 cases. Of these, 4 children were diagnosed with nonunion without avascular necrosis. The main presenting symptom was instability in 1 case, deformity in 1 case, and stiffness of the injured finger in 2 cases. The preoperative range of motion was difficult to assess in the case with instability because the finger was flail. In the remaining cases, the preoperative percentage total active motion (TAM) was 37%, 33%, and 30% of the contralateral finger. Radiologically, all cases had atrophic nonunion. All cases were managed by debridement of the sclerotic bony edges and fixation with a single longitudinal K-wire. Bone grafting was used in the case presenting with instability. Union was achieved in all cases. At final follow-up, the percentage TAM was 61%, 65%, 89%, and 70% for the 4 cases. The outcome was considered good in 1 case and fair in 3 cases. Surgical management of nonunited pediatric phalangeal neck fractures of the fingers was effective in correcting the preoperative instability and deformity and in improving motion of the injured finger. However, there was residual stiffness of the injured finger.