Closed wedge osteotomy for middle phalanx physeal injuries associated with angulation deformities in children

Abstract

Background Middle phalanx physeal fractures in children are rare, and proper treatment gives good results. Despite treatment, these fractures may lead to physeal arrest and growth disturbances leading to severe angulation deformities. Closed wedge osteotomy with internal fixation efficiently corrects the angulation deformities in children. Methods We did a retrospective study analyzing 11 children with middle phalanx physeal injuries and severe angulation. Closed wedge osteotomy and internal fixation with plate and screw were done. We interpreted the pre- and postoperative correction of angles, middle phalanx length discrepancy, technical aspects, range of movement, grip strength, pain, and functional outcomes. Results The mean age of the patients was 10.5\xa0years. The mean follow-up was 28\xa0months (range 24–30\xa0months). Ten of the 11 patients achieved good radiological union, range of motion, and good outcome. None of the patients had growth plate deformity in the follow-up. All patients had a significant correction of angulation/deformity, length, and improvement of grip strength in the postoperative period ( p \u2009<\u20090.05). None had physeal disturbances/abnormalities in the follow-up. Conclusions Though middle phalanx physeal fractures are rare and innocuous, adequate treatment is essential to prevent angulation and growth disturbances. Close wedge corrective osteotomy and internal fixation with plates and screws provide stable and rigid fixation. Greater attention is needed to follow-up them until skeletal maturity. Level of evidence IV.