Complications of Distal Phalanx Fractures in Children.

PURPOSE: To determine whether the incidence of complications varies between among types of distal phalangeal fractures in a pediatric population.

METHODS: We retrospectively reviewed the medical records and radiographs of patients seen in the pediatric hand surgery clinic from 2011 to 2012 with a diagnosis of distal phalanx fracture. Patients were identified by International Classification of Diseases-Ninth Revision code (816.02 or 816.12). We reviewed 206 charts and included them in the study. Demographic data, location of the fracture, specific diagnosis, mechanism of injury, outcomes, and complications were recorded. The treating physicians clinically identified the outcomes and complications.

RESULTS: Average age of patients was 7.5 years. Fracture distribution was tuft (37%), mallet (18%), Salter-Harris I/II (13%), shaft (11%), base (11%), Seymour (6%), Salter-Harris III/IV (2%), and tip amputation (1%). Complications occurred in 31% of patients. The highest rates were for Salter-Harris IV (100%), Seymour (62%), and mallet fractures (49%). There was a statistically significant difference in complication rate by diagnosis. The most common complications were infection (22%), stiffness (15%), and nail deformity (13%).

CONCLUSIONS: Complications of distal phalanx fractures in children are frequent. The incidence varies by fracture type, the highest of which are for Salter-Harris IV, Seymour, and mallet fractures. Special care needs to be taken to reduce the complication rates of these common fractures.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.