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Pediatric Phalangeal Neck Ostectomy for Management of Malunion

March 01, 2019

Contributors: Alice Chu, MD; Dylan Lowe, MD; Brandon Shulman, MD; Brandon Shulman, MD

Phalangeal neck fractures are relatively uncommon in children; however, their unique anatomy requires special management. Although nonsurgical treatment is the mainstay for management of most phalangeal fractures in children, displaced neck fractures of the proximal and middle phalanx are associated with a high risk of malunion because of their poor remodeling potential, which is thought to be a result of their distance from the phalangeal physis. Phalangeal neck malunions often result in loss of motion at the interphalangeal joint. In these patients, an ostectomy or osteotomy often is required to restore alignment and improve motion. This video demonstrates phalangeal neck ostectomy for management of a phalangeal neck malunion. The video provides an overview of the pathogenesis, diagnosis, and management of phalangeal neck fractures followed by a discussion of the indications for surgical management in patients with a malunion. The video discusses the case presentation of an 8-year-old boy who sustained a right little finger hyperflexion injury 3 months prior to presentation. The patient was acutely treated with a splint at an urgent care facility and did not initially seek treatment from an orthopaedic surgeon. Excellent reduction of the little finger proximal phalanx was achieved intraoperatively. The patient was advanced through a standardized rehabilitation protocol with gradual range of motion improvement. Displaced phalangeal neck fractures in children are a challenge to manage and often progress to malunion if managed nonsurgically because of their poor remodeling potential. Phalangeal ostectomy may help restore function in patients with malunion in whom interphalageal range of motion is diminished.

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