Hand fractures in children. A statistical analysis.

A retrospective review of 354 pediatric hand fractures was performed with a minimum follow-up period of two years. The incidence of epiphyseal injury was 34% higher than reported elsewhere in the skeleton. Growth disturbance was extremely rare, occurring only in two patients with severe crush injury and infection. Fracture displacement was most common in the border digits with displacement within a given digit most common in the metacarpal; the next most common were the proximal phalanx and distal phalanges; the least common was the middle phalanx. Malunion most often was associated with failure to obtain adequate true lateral and anteroposterior roentgenograms of the individual digits, failure to evaluate postreduction alignment in a position of full finger flexion, and was based on an erroneous assumption that a growth would correct for deficient reduction. Although nondisplaced intra-articular fractures uniformly healed without malfunction, poor functional results were obtained from displaced intra-articular fractures. The following injuries presented particular problems: displaced intra-articular fractures, Salter I distal phalangeal fractures due to crushing injuries, displaced subcondylar fractures, and open fractures.