Baur Alexander, Anthony Taylor, Lustig Keith, Lee Michael L
Research Department, Liberty University, Lynchburg, VA 24502, USA.
Department of Orthopaedics, Valley Hospital Medical Center, Las Vegas, NV 89106, USA.
Pediatr Rep. 2025 Aug 6;17(4):82. doi: 10.3390/pediatric17040082.
Finger injuries are common in pediatric patients and typically heal well with conservative management. However, rare fracture patterns involving significant displacement and physeal injury, such as the one described in this case, require specialized surgical intervention to ensure proper healing and prevent long-term complications. A 12-year-old left-hand-dominant female presented with pain, swelling, and deformity at the distal interphalangeal (DIP) joint following hyperextension of the left fifth digit. Initial radiographs revealed a volar displaced intra-articular fracture with physis involvement, confirmed by computed tomography (CT) imaging. Conservative management with closed reduction and splinting failed to achieve adequate alignment. Surgical intervention was performed via a dorsal approach, utilizing ORIF with K-wire fixation to restore joint congruity and ensure anatomic alignment. Postoperative follow-up demonstrated satisfactory healing, maintained reduction, and resolution of pain with no complications. The patient regained functional use of the digit with minimal stiffness, and the growth plate remained uninvolved during the recovery period. This case underscores the importance of advanced imaging, early referral, and tailored surgical intervention for rare mallet fractures involving volar displacement and physeal injury. ORIF provided reliable stabilization and optimal outcomes in this complex case. Volar displaced Salter-Harris III fractures of the DIP joint are rare and challenging injuries in pediatric patients. This case highlights the role of ORIF in achieving successful outcomes and emphasizes the importance of precise reduction and stabilization to prevent long-term complications.
手指损伤在儿科患者中很常见，通常采用保守治疗就能愈合良好。然而，罕见的骨折类型，如本病例中所描述的涉及明显移位和骨骺损伤的骨折，需要专门的手术干预，以确保正确愈合并预防长期并发症。一名12岁、惯用左手的女性，在左手小指过度伸展后，出现远侧指间关节（DIP）疼痛、肿胀和畸形。最初的X线片显示为关节内掌侧移位骨折并累及骨骺，计算机断层扫描（CT）成像证实了这一点。采用闭合复位和夹板固定的保守治疗未能实现充分对线。通过背侧入路进行手术干预，采用切开复位内固定术（ORIF）并用克氏针固定，以恢复关节一致性并确保解剖学对线。术后随访显示愈合良好，复位得以维持，疼痛缓解，无并发症。患者手指功能恢复，仅有轻微僵硬，恢复期间生长板未受累。本病例强调了对于罕见的伴有掌侧移位和骨骺损伤的锤状指骨折，先进影像学检查、早期转诊和针对性手术干预的重要性。在这个复杂病例中，切开复位内固定术提供了可靠的固定并取得了最佳效果。DIP关节掌侧移位的Salter-Harris III型骨折在儿科患者中罕见且具有挑战性。本病例突出了切开复位内固定术在取得成功结果中的作用，并强调了精确复位和固定以预防长期并发症的重要性。
