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Pediatric Proximal Phalanx Base Fractures in Fingers: Identifying the Need for Surgical Management
Nicole E Look, M.D.1; Hannah Korrell, B.S.2; Andy E Lalka, MPH2; John Schutz, BS2; Gabriela Cleary, BS3; Johanna Hild, BS3; Frank A Scott, MD2; Micah K Sinclair, MD4; Sarah E Sibbel, MD5
1University of Colorado, Aurora, CO; 2University of Colorado School of Medicine, Aurora, CO; 3Kansas City University of Medicine and Biosciences, Kansas City, MO; 4Mercy Children's Hospital, Kansas City, MO; 5Children's Hospital Colorado, Aurora, CO

Introduction:
Fractures of the base of the proximal phalanx are among the most common finger fractures in children. Immobilization with or without a closed reduction of the digit for 3-4 weeks can lead to good results. The purpose of this retrospective study is to evaluate the change in angular deformity with and without reduction of proximal phalanx base fractures at final follow up.
Methods:
A multi-institutional retrospective review of skeletally immature patients treated for a proximal phalanx base fracture between years 2002-2019. The variables collected included: demographics, initial and final angulation and displacement on the lateral and anteroposterior views, treatment group, malunions, Salter Harris classification, and time union. Patients with less than 3-weeks follow up, inadequate medical record details, or missing radiographs were excluded.
Results:
Six hundred and forty four subjects met the inclusion criteria and were categorized into non-operative, closed reduction, and operative groups. The average age at time of fracture was 10.8 years. Salter Harris II fractures were the most common injury (85.2%, P=0.082). The largest mechanism of injury being sports 51.9% followed by fall 31.4%. The small 53.8% and ring 15.4% fingers were injured most frequently (P=0.001). There were six malrotations, three in the non-operative and three in the closed reduction group for an overall (0.93%) malrotation rate. Non-operative, closed reduction, and operative groups initial and final median coronal deformity: (2 vs 16 vs 15.1, P=0.0001) and (2 vs 4 vs 1.5, P=0.0001) respectively, differed significantly between and within groups. Similarly initial and final median sagittal angular deformity (2 vs 8 vs 11, P=0.0001) and (2 vs 3 vs 3, P=0.0022) respectively, differed significantly between and within groups. Initial median AP displacement (0 vs 0.85 vs 1.6, P=0.0001) was significantly different between and within groups.
Conclusion:
A limited number of proximal phalanx base fractures require surgical management. The great majority can be treated with closed reduction in the emergency room or clinical setting without sedation, resulting in equivalent outcomes of minimal angular deformity. Current treatment methods have led to good results with correction of angular deformity to 2 in both the sagittal and coronal planes at final follow-up.


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