Ho-Jung Kang, et al. lines was determined as the radial and ulnar an- gulation. Dorsal and palmar angulations were determined on the true lateral view. These angula- tions were also measured as the angle formed by two lines. One line bisected the distal articular surface and ran parallel to the palmar or dorsal cortex of the distal fragment, and the other was drawn through the center of the shaft. The frac- tures were classified into three types. Type I frac- tures were not displaced and without finger de- formity. In Type II fractures, the distal fragment was displaced but maintained some bone to bone contact with the proximal fragment. In type III fractures, there was no bony contact between the proximal and distal fragment.9 Open reduction was indicated in patients with fractures that were not reduced by an initial treatment of closed reduction, unstable fractures which were not maintained after reduction, malunited fractures because of failure of conservative treatment and gross rotational defor- mity of the nail plane in full grip. The average length of immobilization with a finger splint and pin removal was 3.5 weeks (range: 3-5 weeks). Distal interphalangeal joint motion was allowed immediately after the operation, and proximal interphalangeal joint motion was started after pin removal. For the follow-up study, the following data were recorded: deviation of the finger during active maximum extension, degree of flexion of finger grip, relief of pain, and the subjective cos- metic result. Objective data on the functional positions of the hand needed for performing daily activities were analyzed using standard techniques to assess active and functional ranges of motion (ROM) of the proximal interphalangeal joint. The results were rated as follows: "excellent" indicates fracture union plus full ROM of the proximal interphalangeal joint, no clinical deformity, less than 5 angulation in any plane, no rotation, no pain, and no infection; "good" indicates fracture union and one criterion missing; "fair" indicates fracture union with two criteria missing; and "poor" indicates fracture union with three criteria missing based on this grading system. RESULTS The age of the patients ranged from 2 to 14 Yonsei Med J Vol. 46, No. 4, 2005 years (average: 4.8 years) at the time of surgery. There were 14 boys and 10 girls. The dominant hand was involved in 15 of the 24 patients. The little finger was the most frequently involved finger (10 patients), followed by the index finger (4 patients). The most common cause of injury was sports-related (12 patients). Two cases were caused by slipping and falling and 6 were crushing injuries. Four patients had door- slam in- juries. Ulnar angulation was noted in six patients (Fig. 1) and radial angulation was seen in two patients. On the lateral view, dorsal or volar dis- placement of the distal fragment was seen in 16 patients. Dorsal displacement with volar angula- tion greater than 45 was present in 12 patients (Fig. 2), volar displacement with dorsal angulation greater than 45 was present in two patients, and mild volar displacement was present in two patients. Three of 12 patients with dorsal displace- ment of the distal fragment, with volar angula- tion, had 180 rotation of the head. There were 4 patients with Type I fractures, 17 with Type II, and 3 with Type III fractures. There was one open fracture. Four Type I frac- ture patients had closed reduction and percuta- neous pinning. Open reduction and internal fixa- tion was done in Type II and Type III patients. The interval between trauma and operation Fig. 1. An 11-year-old boy had a crushing injury to his middle finger during a car accident. Anteroposterior radiographs show the proximal phalangeal neck fracture.