Phalangeal and Metacarpal Fractures in Children: A 10-Year Comparison of Factors Affecting Functional Outcomes in 313 Patients.

It is widely believed that fractures in children have excellent clinical outcomes due to their capacity to remodel. There are, however, certain fractures that require careful management to avoid long-lasting functional impairment. Functional outcomes following hand fractures in children are poorly studied.  We performed a retrospective cohort study of consecutive children and adolescents who had operative treatment for metacarpal and phalangeal fractures (2008-2018). Tuft fractures and replantations were excluded. Functional outcomes were measured by total active motion (TAM) scoring, where a "good" outcome = TAM > 75%. Fractures were categorized by location, classification, and by the fixation they required.  Three hundred thirteen children were included. For proximal phalangeal fractures, those treated by manipulation under anesthesia, had a higher proportion of "good" functional outcomes than Kirschner-wire or open reduction internal fixation at discharge from hand therapy (  = 0.043). Middle phalanx fractures had excellent functional outcomes, with no difference between fixation methods (  = 0.81). For metacarpals, there was no statistically significant difference in functional outcomes across all managements (  = 0.134). Fractures in the thumb had poorer postoperative function at mean 7.26 weeks than those in the long fingers (  < 0.0001), and the data suggested a trend toward worse outcomes in the distal phalanx, pediatric Bennett fractures, Seymour fractures, and oblique fractures.  Fractures in the thumb and phalangeal fractures that require percutaneous or open fixation may need closer early postoperative monitoring in children to optimize their potential for good function.