Long term Clinical Outcomes for Salter-Harris Type II Fractures of the Proximal Phalanx of the Small Finger ("Extra-Octave" Fractures)
Lily Wood, MD1; Lynsey R Malin, MS1; Jennifer Robb, PhD2; Deborah Bohn, MD3
1University of Minnesota, Minneapolis, MN; 2TRIA, Bloomington, MN; 3Orthopaedics, University of Minnesota, Minneapolis, MN
Introduction: Juxta-physeal fractures of the small finger proximal phalanx (P1) (“extra-octave fractures”) are common in children. Guidelines on indications for surgical management, acceptable coronal plane malangulation, and long-term outcomes for these fractures are not available. We sought to assess long-term patient-reported outcomes (PROs) regarding function, pain, and appearance after nonoperative management of extra-octave fractures.
Materials and Methods: Our hospital PACS database was queried using the search term, “XR-Finger Little.” Skeletally immature patients aged 8 to 16 years at time of injury with a juxta-physeal fracture of the small finger P1 were included. Eligible subjects were contacted by phone and sent surveys electronically. Questions regarding subjective appearance, function, and pain were assessed with VAS (0-100). The PROMIS v2.0 Pediatric Upper Extremity short form was used as the PRO. Displacement on injury radiographs was calculated using the diaphyseal-metacarpal head angle. Parents were asked to upload photographs of their child’s hands in certain positions. These photographs were compiled into a survey that was sent to hand experts to determine if there was visible residual deformity of the small finger. T-tests were used to compare parent and child responses and ANOVA was run to examine the impact of demographic variables on PROs.
Results: Our PACS query generated 1307 studies. 41 parents and 38 patients completed surveys. The average age at time of injury was 11.1 years and average age at time of survey completion was 17.2 years. The mean coronal plane angulation at injury was 9.85 0 (SD 6.95, range 1-26°). Patient and parent perceptions of appearance and function were good to excellent (83.95 22.87 vs. 83.84 25.08 for appearance, 93.95 11.62 vs. 97.13 6.43 for function). Median pain score for the 38 patient respondents was 0 (no pain). All patients reported full function scores (30/30) on the PROMIS short form. There was significant variation by hand experts in the correct identification of the injured finger on photographs, F(2, 240) = 19.527, p < 0.0001, ?² = 0.13. Combined, experts correctly identified the injured digit on only 40% of the images.
Conclusions: To our knowledge this is the largest study examining patient-reported function, appearance and pain at long term follow up after extra-octave fractures treated nonoperatively. At mean 6-year follow up 100% of children and parents reported excellent function and appearance of the previously injured finger. Our findings support nonoperative management of extra-octave fractures with up to 26° of coronal plane angulation.
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