Outcomes of intramedullary screw fixation in pediatric proximal phalanx fractures: A prospective case series.

Abstract

Background: This prospective case series aimed to evaluate the short- to medium-term radiological and clinical outcomes of intramedullary screw (IMS) fixation in pediatric patients with extra-articular proximal phalanx fractures.

Methods: Eleven patients (eight boys and three girls) aged 5-15 years underwent IMS fixation between January 2020 and June 2022. Antegrade or retrograde techniques were used depending on the fracture location. Postoperatively, patients were immobilized with finger splints for 3-5 days, followed by home exercises and physiotherapy. Bone union and functional status were assessed at one and four weeks after rehabilitation. Patient satisfaction, union status, and finger range of motion were also evaluated. Satisfaction outcomes were categorized as excellent, good, fair, or poor.

Results: The mean patient age was 9.4 years (range: 5-15), and the mean follow-up period was 29.1 months (range: 24-36). The right hand was affected in eight cases, the left hand in three cases, and the dominant hand in eight cases. Fracture distribution included four neck, four shaft, and three base fractures. The mechanisms of injury included ball-related trauma (n=5), falls (n=3), crush injuries (n=2), and punching (n=1). The average time from injury to presentation was 2.5 days (range: 0-9). Seven patients underwent surgery using the retrograde fixation technique, while four patients underwent surgery using the antegrade fixation technique. Fracture union was observed within the first month in nine patients and was complete by the end of the second month in two patients. At the last follow-up, the range of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the operated finger was assessed. Deficits of 1.8 (range: 0-10), 2.7 (range: 0-10), and 0.9 (range: 0-10) were observed when compared to the contra-lateral side, respectively. Ten patients demonstrated excellent outcomes, while one patient exhibited a good outcome.

Conclusion: The intramedullary screw technique offers significant advantages in the surgical management of pediatric proximal phalanx fractures, particularly in rural areas with low socioeconomic status. This approach eliminates the need for pin-bottom fixation with a K-wire, significantly reduces hospitalization and additional treatment requirements, and minimizes the adverse impact of familial factors on the therapeutic process.