Yonsei Medical Journal Vol. 46, No. 4, pp. 491 - 495, 2005 Operative Treatment for Proximal Phalangeal Neck Fractures of the Finger in Children Ho-Jung Kang,1 Seung-Yong Sung,2 Jung-Won Ha,2 Hong-Kee Yoon,1 and Soo-Bong Hahn1 1Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea; 2Department of Orthopedic Surgery, National Health Insurance Corporation, Ilsan Hospital, Kyonggi-do, Korea. Displacement and inappropriate treatment of a proximal phalangeal neck fracture may result in malunion of the fracture with consequent loss of motion and gross deformity, especially in children. We performed a retrospective study of twenty-four patients who had undergone operative treatment for a proximal phalangeal neck fracture, with a mean follow-up evaluation of 14 months (range: 12-30 months). We analyzed the types of fractures, their causes, operative treatments, complications, and functional outcomes. The age of the patients ranged from 2 to 14 years (average: 4.8 years). Twenty of the 24 patients had open reduction and internal fixation, and fourteen of these 20 patients had criss-cross pin fixation. Four of the 24 patients had closed reduction and percutaneous pinning. The average length of immobilization was 3.5 weeks. Excellent or good results were seen in 18 patients (75%). Two patients had complications, which included volar angular deformity and mild button-hole deformity. We recommend that careful initial radiography, particularly, true lateral view radiographs, be required for proper diagnosis. The best results can only be obtained with accurate anatomical reduction of the fracture and early active motion exercise. Key Words: Children, proximal phalangeal neck, fracture INTRODUCTION Although the hand is generally exposed to all kinds of injuries, the proximal phalangeal neck is particularly vulnerable to trauma, especially in children.1-3 These fractures are likely to be mis- sed, unless they are confirmed by careful physical Received August 5, 2004 Accepted March 29, 2005 Reprint address: requests to Dr. Seung-Yong Sung, Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital, 1232 Baeksok-dong, Ilsan-gu, Koyang-shi, Kyonggi- do 411-719, Korea. Tel: 82-31-900-0445, Fax:82-31-900-0343, E-mail: Sysung@nhimc.or.kr examination and radiographic study.4 If the ap- propriate treatment plan is not selected, phalan- geal neck fracture in children may result in malunion of the fracture, deformity of the hand, stiffness of the affected joint, pain, and accelerated degenerative changes.5-8 Displacement of a frac- ture fragment in a phalangeal neck fracture is usually more severe in the proximal phalanx than in the middle phalanx. However, there are few reports on the results of treatment in proximal phalangeal neck fractures in children.6 This paper presents data from a retrospective study on proxi- mal phalangeal neck fracture in children to iden- tify the types of fractures, their causes, operative treatments, complications, and functional out- comes. MATERIALS AND METHODS We reviewed the records of 24 children who were treated for proximal phalangeal neck frac- ture from January 1990 to January 1998. Patients were followed up until they had complete bony union and recovery of proximal interphalangeal movement, for a mean of 14 months (range: 12-30 months). Unicondylar or bicondylar head frac- tures were excluded. Anteroposterior (AP), true lateral, and oblique radiographies were reviewed. The fracture angle was measured on AP and lat- eral films. On the AP view, we drew a line through the center of the shaft of the proximal phalanx. Next, the radial and ulnar margins of the distal articular surface of the proximal phalanx were connected and a second line was drawn per- pendicular to that. The angle formed by those two Yonsei Med J Vol. 46, No. 4, 2005