Pediatric Juxta-Epiphyseal Phalangeal Fractures are Distinct from Salter-Harris Fractures and More Frequently Need Operative Fixation
Kyle Y. Xu, M.D., Alyx Posorske, B.S., Alexander Y. Lin, M.D., Christina Plikaitis, M.D..
Saint Louis University School of Medicine, Saint Louis, MO, USA.
PURPOSE: Salter-Harris type 2 (SH2) fractures are the most common pediatric phalangeal fracture. A juxta-epiphyseal (JE) fracture is a distinct fracture pattern that, although similar in radiographic appearance, occurs 1-2 mm distal to the growth plate involving the metaphysis only. Although the radiographic differences are subtle, we believe there are important differences in behavior and management of these two fractures.
METHODS: An IRB-approved retrospective chart review was conducted of patients presenting to our tertiary care center. 97 patients with either SH2 or JE finger fractures were identified and charts analyzed.
RESULTS: SH2 fractures were more common than JE fractures (85% vs. 15%). There was no significant difference between the two fracture types in patient’s age, gender, or mechanism of injury. JE fractures were radiographically more angulated on presentation than SH2 fractures (mean angulation 18.29 vs. 11.32 degrees, p=0.02). JE fractures required significantly more operative fixation by closed reduction and percutaneous pinning compared to SH2 fractures (42.9% vs. 10.8%, p=0.002). There was no difference in outcome obtained between the two groups.
CONCLUSION: Despite their similarities in clinical and radiographic presentation, pediatric JE phalangeal fractures are a distinct entity from SH2 fractures. Presenting with significantly more radiographic angulation and clinical instability, JE fractures more frequently required operative fixation compared to SH2 fractures. This distinction is important when determining the treatment strategy employed (operative fixation versus nonoperative management) as well as potential length and degree of immobilization/stabilization for nonoperative management to increase the success of treatment.
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