Abstract
Background: Several authors have indicated that there are specific poor prognostic factors which may affect the outcome of management of phalangeal neck fractures. In the authors' centre, phalangeal neck fractures with any of these poor prognostic factors are labelled "troublesome". Any of the following five criteria will qualify the fracture to be regarded as "troublesome": concurrent vascular compromise of the fractured digit, open/partial amputation injuries, comminution of the fractured phalangeal head, concurrent epiphyseal or juxta-epiphyseal fractures distal to the fractured phalangeal head, and all Type III fractures (as per Al-Qattan classification).
Methods: The effect of these poor prognostic factors has not been investigated in the youngest paediatric age group; the hands of whom are known to be most forgiving. The purpose of this study is to compare the outcome of management of seven "troublesome" vs nine "non-troublesome" phalangeal neck fractures in children less than 2 years of age. Demographic data (age, sex, fracture site/type, and troublesome factors) were reviewed for the 16 cases. All patients were treated according to a specific protocol, and the outcome was documented using a modified Al-Qattan's outcome grading system.
Results: Of the nine children with non-troublesome fractures, eight obtained a satisfactory outcome and the ninth case had an unsatisfactory outcome. In contrast, all seven children with troublesome fractures had an unsatisfactory outcome and the difference was highly significant (p = 0.0007).
Conclusion: The authors strongly advise discussing the outcome of troublesome fractures with the parents and also advise documenting this in the file (prior to management) for medico-legal reasons.