Proximal interphalangeal joint hyperextension injuries in children

Abstract

Background: Proximal interphalangeal joint (PIPJ) hyperextension injuries are common in children. There is a range of opinion on management but little evidence to suggest best practice.

Aims: To determine from a convenient sample size, the overall and significant fracture rate. Whether significant injuries can be differentiated from the insignificant clinically and whether children get complications.

Methods: Data were collected on all PIPJ hyperextension injuries (thumb excluded) presenting to a children’s emergency department between October and December 2006. Staff were trained to perform standardised assessment and documentation and all injuries were x rayed. The diagnosis was cross-referenced with x ray reports. All notes were reviewed for 4 months. Management, complications and unscheduled returns were noted.

Results: From the population of 134 patients, there was a fracture rate of 55% (74/134). Of those, 57% (42/74) were defined as significant. Others included buckle (9/74), flake (14/74) and avulsion (9/74) fractures. Obvious deformity and inability to touch pulp to palm were significantly associated with a fracture. Except for those with clinical deformity requiring manipulation, all injuries were treated conservatively. There were no unscheduled returns with any complications 4 months post-injury.

Conclusions: There is a significant risk of a fracture in children sustaining hyperextension injuries to the PIPJ. These results show that, except in those with an obvious deformity, it is difficult to differentiate clinically between those with a sprain, minor or significant fracture. Even those with a significant fracture were managed conservatively. Children appear not to have the complications seen in the adult population with similar injuries.