소아수지의 근위지골 경부골절의 수술적 치료

Abstract

Purpose : Proximal phalangeal neck fractures in children are relatively uncommon and easily misdiagnosed if acurate radiologic evaluation is not obtained. We retrospectively analyzed 28 patients who had operative treatment for proximal phalangeal neck fractures. Methods : Initial standard anteroposterior, true lateral, and both oblique x-ray views of the involved finger were taken thoroughly. Minimally displaced fractures were undergone closed reduction and percutaneous pinning. Open reduction and percutaneous pinning was performed in case of unstable fracture, radial or ulnar angulation of 10¡Æ or more, volar or dorsal angulation of 15¡Æ or more, malunited fractures, and gross deviation or rotation deformity clinically. Result : The average length of follow-up was 12 months. Eight cases were treated with closed reduction and percutaneous criss-cross K-wire or 23 gauge needle pinning, which had a displacement of less than 1mm or angulation of less than 15¡Æ. Twenty cases required open reduction and internal fixation. Excellent or good results were noted in 20 cases(71%). Complications were found in 7 cases including limitation of motion, gross deviation and button-hole deformity. Conclusion : Proximal phalangeal neck fractures in children must be reduced acurately to avoid long-term disability. The open reduction can be a effective treatment for displaced or malunited fractures.