Managing Finger Fractures in Children

Children can experience finger fractures for a variety of reasons including crush injuries (finger slammed in car door), sports trauma, and even fights. Fractures in skeletally immature children can lead to some complex and challenging problems — especially if the extent of the injury is not recognized right away. For example, separation of the bone from the joint can result in a finger dislocation if not treated properly at the start.

In this article, a pediatric orthopedic surgeon from Cincinnati Children’s Hospital in Ohio uses two patient examples to discuss the types of fractures that can “go south” or “get ugly.” For example, the growth plate can be damaged affecting finger growth. The bones may twist or rotate after breaking and shifting apart. The fracture itself might be unstable and the bones easily bent or angled.

If the growth plate at the end of the bone is broken and the nail plate is avulsed (pulled away from the skin fold), the broken bone can be left open to infection-causing bacteria. This type of break is called a Seymour fracture.

Additional problems develop when a Seymour fracture is not recognized and the finger is splinted or immobilized. Healing will not occur, infections are common, and the fracture remains unstable. Surgery is necessary to pull the nail plate off and get the area cleaned out (a procedure referred to as irrigation and debridement). Only then will the fracture heal and nail bed repair itself. The recovery time is usually three to four weeks.

Certain types of finger fractures in children will require surgery to avoid malunion. These include phalangeal neck and condyle fractures. A phalangeal neck fracture occurs in the bone just outside the finger joint. A condyle fracture refers to a similar break but one that does affect the joint. Undetected, either one of these fractures will result in malunion and joint dysfunction if not treated surgically (reduction and fixation procedure).

The author suggests that many of these problems can be avoided with proper evaluation and examination. X-rays of each individual finger must be done. Relying on a hand X-ray where the finger bones overlap when viewed from the side is not advised. Early detection of the full extent of finger fractures and soft tissue damage in children is the key to disrupting finger growth and restoring full joint and finger function.