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Ossification of the Proximal and Middle Phalangeal Condyles: A tool to Aid in Phalangeal Neck Fracture Reduction
Joshua Abzug, MD; Shusterman Igor, MSII
University of Maryland Medical Center, Baltimore, MD

Introduction: Phalangeal neck fractures are common injuries in children. Due to the location of the fracture being distant from the physis, remodeling may be unpredictable and slow. Furthermore, near anatomic alignment is necessary to restore the retrocondylar recess, thus permitting restoration of full digital flexion. However, assessment of the alignment may be limited in children, as the condyles may not be completely ossified. The purpose of this study was to assess the ossification of the proximal and middle phalangeal condyles to determine if a line drawn along the volar cortex of the phalynx can be used to predict where the intersection with the phalangeal condyle should be based on the patients' age.
Materials & Methods: Lateral radiographs of the hand were obtained for children aged 5, 10, 15 and 18 years. Thumbs and digits with an injury present were excluded. A line was drawn anteriorly along the volar cortex of the proximal and middle phalanges of each digit and a second perpendicular line was then drawn at the level of the phalangeal neck. A ratio of the anterior to posterior aspects of the phalangeal condyle was determined at the intersection of these lines. Demographic data was also collected to determine if gender had a significant influence on ossification timing.
Results: The volar phalangeal line intersected at 29% for both the proximal and middle phalangeal condyles for 5 year olds (n=50), at 35% for 10 years olds (n= 60), at 37% for 15 year olds (n= 156), and at 40% for 18 year olds (n=102). Significant linear regression (r=0.899) was present confirming that more of the condyle is volar to this line with increasing age. No differences were noted due to gender.
Conclusions: Restoration of the retrocondylar recess is critical to obtaining full range of motion at the interphalangeal joints following phalangeal neck fractures. Assessment of a line drawn along the volar cortex of the phalanges may be necessary to obtain anatomical alignment. Knowledge of the ossification timing will aid in utilizing this tool during phalangeal neck fracture reduction and fixation in children.


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