Operative Treatment for Proximal Phalangeal Neck Fractures of the Finger in Children A B Fig. 2. Lateral radiographs reveal that the distal fracture fragment was displaced dorsally. Fig. 4. (A, B) Eight weeks after the operation, union was achieved. A B Fig. 3. (A, B) Open reduction and internal fixation with two Kirschner's wires was performed. ranged from 2 days to 2 months, with a mean of 18 days. Seven patients had closed reduction and splint immobilization treatment at private clinics when initially injured. Six patients were trans- ferred to the author's institution because of de- layed recognition of a displaced and rotated frac- ture fragment. Four patients also reported feeling instability in the proximal interphalangeal joint. The operative technique was as follows. A skin incision was made in the dorsal midline over the fracture site. A parasagittal incision through the transverse retinacular ligament with mobilization of the central tendon was needed in six of 14 patients in whom midline dorsal incisions were made (Fig. 5). Open reduction and internal fixa- tion with 0.035-inch Kirschner (K) wires (8 patients), 23-gauge needles (11 patients) or pull- out steel wire with K wire (1 patient) was done. Criss-cross fixation was performed in 14 patients (Fig. 3, A and B). Single K wire fixation was used for the others. Osteoclasis was performed in six patients with malunited fractures. No bone graft was performed for malunions. Twelve patients (all Type I & 8 Type II) had excellent results, six patients (Type II) had good results, four patients (3 Type II & 1 Type III) had fair results, and two patients (Type III) had poor results. Complete ROM, grip, and pinch strength were restored in 16 of the 24 patients. After the operation, the radiographs revealed no avascular necrosis or traumatic joint damage around the injury site (Fig. 4, A and B). Complications developed in 2 patients. One mild buttonhole deformity occurred, but there was no functional disturbance. Volar an- gular deformity greater than 15 was present in one patient with a severe dorsal communited frac- ture one week after K wire removal. Callus over- Yonsei Med J Vol. 46, No. 4, 2005