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Hand fractures in children

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Metacarpal and phalangeal fractures

In these fractures, the most important thing is to ascertain that there is no finger malrotation (when making a fist, the affected finger crosses over the others, thus hindering the hand function) (Fig. 23A). If there is no malrotation, treatment is conservative by immobilizing with a splint (Fig. 23B). If there is a malrotation, the prefered treatment is surgical: closed reduction and with Kirschner-wire or screw fixation (Figure 23C).

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Figure 23A
. Fracture with finger malrotation. Requires open reduction and internal fixation.

 

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Figure 23B
. Treatment using a digital splint.


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Figure 23C
. Metacarpal fracture. Fixation with a screw.

Some fractures require special mention:

Subcapital fractures of the first phalanx

These are fractures of the distal metaphysis. More common in the pinkie. They require accurate reduction, because they can limit the closure of the finger, by the clash between the base of the second phalanx and the first phalanx (Fig 24). It is especially important in the fourth and fifth fingers, since they have more grip function and require more mobility in flexion.

In healed fractures with finger flexion impairment, we can do surgery (osteoplasty) to facilitate the closure of the finger (Fig 25).
 

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Figure 24
. Subcapital fracture of the first phalanx. The bone protrusion limits finger flexion, thus requiring reduction.
 

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Figure 25
. La fractura subcapital unió en posición inadecuada por lo que fue necesario hacer una osteoplastia.


Fractures of the base of the first phalanx of the little finger
Typically, the pinky deviates outward. It is reduced by the pencil maneuver, which is placed between the fingers and provides a fulcrum (Fig 26).

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Figure 26
. Typical fracture of the base of the first phalanx, with deviation of the little finger out.


Mallet Finger  (Fig 27)

Deformity of the finger characterized by a fall of the distal phalanx due to a terminal extensor tendon injury or a bone avulsion at the base of the third phalanx.

Tendinous mallet finger is usually treated with a splint for 8 weeks. Fractured mallet finger, at present, is also non-surgically treated.
 

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Figure 27
. Mallet finger caused by a tendon injury

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