Percutaneous reduction of incipient malunion of phalangeal neck fractures in children

In this article we describe our treatment of partially healed malaligned fractures of the phalangeal neck in children. This was a retrospective study of 8 pediatric patients with phalangeal neck fractures who presented late for care to Children’s Hospital in Boston. All patients were diagnosed clinically and radiographically with advanced partial healing of their fracture in a malunited position of extension. The 8 patients were followed up until fracture healing and restoration of normal motion and function were achieved. A K-wire was inserted into the fracture site through the dorsal callus and used to mobilize the fracture fragment by breaking down the fracture callus and partially healed bone. The wire then was used as a lever arm for fracture reduction. A separate wire was used to pin the fracture percutaneously. This treatment corrects the loss of flexion that occurs with a malunion in the phalangeal subcondylar fossa. It is a minimally invasive procedure that avoids the soft-tissue dissection of an open procedure.