Lankachandra Manesha, Wells Corey R, Cheng Christine J, Hutchison Richard L
Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, MO.
University of Missouri-Kansas City School of Medicine, Kansas City, MO.
J Hand Surg Am. 2017 Jul;42(7):574.e1-574.e6. doi: 10.1016/j.jhsa.2017.03.042. Epub 2017 Apr 29.
To determine whether the incidence of complications varies between among types of distal phalangeal fractures in a pediatric population.
We retrospectively reviewed the medical records and radiographs of patients seen in the pediatric hand surgery clinic from 2011 to 2012 with a diagnosis of distal phalanx fracture. Patients were identified by International Classification of Diseases-Ninth Revision code (816.02 or 816.12). We reviewed 206 charts and included them in the study. Demographic data, location of the fracture, specific diagnosis, mechanism of injury, outcomes, and complications were recorded. The treating physicians clinically identified the outcomes and complications.
Average age of patients was 7.5 years. Fracture distribution was tuft (37%), mallet (18%), Salter-Harris I/II (13%), shaft (11%), base (11%), Seymour (6%), Salter-Harris III/IV (2%), and tip amputation (1%). Complications occurred in 31% of patients. The highest rates were for Salter-Harris IV (100%), Seymour (62%), and mallet fractures (49%). There was a statistically significant difference in complication rate by diagnosis. The most common complications were infection (22%), stiffness (15%), and nail deformity (13%).
Complications of distal phalanx fractures in children are frequent. The incidence varies by fracture type, the highest of which are for Salter-Harris IV, Seymour, and mallet fractures. Special care needs to be taken to reduce the complication rates of these common fractures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
确定小儿人群中不同类型的远节指骨骨折并发症的发生率是否存在差异。
我们回顾性分析了2011年至2012年在小儿手外科门诊就诊且诊断为远节指骨骨折患者的病历和X线片。通过国际疾病分类第九版编码（816.02或816.12）来识别患者。我们查阅了206份病历并将其纳入研究。记录人口统计学数据、骨折部位、具体诊断、损伤机制、结果和并发症。主治医生通过临床确定结果和并发症。
患者的平均年龄为7.5岁。骨折分布情况为：指骨粗隆骨折（37%）、锤状指骨折（18%）、Salter-Harris I/II型骨折（13%）、骨干骨折（11%）、基底骨折（11%）、Seymour骨折（6%）、Salter-Harris III/IV型骨折（2%）以及指尖离断伤（1%）。31%的患者出现了并发症。Salter-Harris IV型骨折（100%）、Seymour骨折（62%）和锤状指骨折（49%）的并发症发生率最高。不同诊断的并发症发生率存在统计学显著差异。最常见的并发症是感染（22%）、僵硬（15%）和指甲畸形（13%）。
儿童远节指骨骨折并发症很常见。并发症发生率因骨折类型而异，其中Salter-Harris IV型骨折、Seymour骨折和锤状指骨折的发生率最高。需要特别注意降低这些常见骨折的并发症发生率。
研究类型/证据水平：治疗性IV级。
