11/28. Physeal phalangeal fracture with flexor tendon entrapment. A case report and review of the literature.A typical phalangeal epiphyseal fracture separation in a 12-year-old girl was complicated by a relatively unusual irreducible growth plate injury. Various tissues may become interposed between displaced phalangeal structures preventing realignment. Frequently, the flexor tendon has been implicated as the cause of complex joint dislocations or fracture-dislocations of the digits. However, entrapment of the flexor tendon by the displaced base of a buttonholed phalangeal metaphysis separated from its related epiphysis is quite rare. Treatment required early recognition to avoid further injury, open identification of the tissue derangement, and careful reduction to restore normal function.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
12/28. fibrin glue osteosynthesis of epiphyseal injuries in children.The osteosynthesis of epiphyseal injuries by a two-component fibrin glue was performed in five children. Three of them had finger fractures, two patients had slightly displaced distal tibial and fibular fractures. All children recovered without sequelae. They have been followed for three to twelve months after surgery and did not show any negative consequences. The glue osteosynthesis of physeal injuries will be appropriate only in more stable fractures where the fragments are not exposed to greater dislocating power because this type of synthesis is not very firm. In open injuries it is possible to add antibiotic to the glue, which represents a great advantage compared with the use of metal. It is essential to combine the osteosynthesis with plaster of paris during the whole healing period.- - - - - - - - - - ranking = 1.2keywords = seal (Clic here for more details about this article) |
13/28. Complex dislocation of the index metacarpophalangeal joint in children.Four cases of complex dislocation of the index metacarpophalangeal joint prior to skeletal maturity were reviewed. Despite the generalized laxity present in these children, none of the dislocations could be anatomically reduced by closed methods. Two patients had a concomitant osteochondral fracture from the ulnar side of the metacarpal epiphysis; one subsequently developed a lesion similar to an epiphyseal osteochondroma. One patient developed ischemic necrosis leading to premature growth arrest; a shortened metacarpal, and a deformed metacarpal head. The possibility of vascular damage must be considered in the skeletally immature patient, since the epiphyseal and physeal circulation may be compromised by either the dislocation or exposure for the reduction.- - - - - - - - - - ranking = 0.6keywords = seal (Clic here for more details about this article) |
14/28. Unstable metacarpal and phalangeal fracture treatment with screws and plates.Plate and screw fixation of the metacarpals and phalanges has limited indications but can provide crucial assistance to the reconstructive hand surgeon in the treatment of complex fractures. Screws are indicated for unstable, long oblique or spiral fractures of the metacarpals and phalanges, intraarticular fractures with articular surface involvement in excess of 25% with or without comminution, and intraarticular condylar, T-condylar, and Y-condylar fractures. Plates at the metacarpal level are indicated for segmental defects with substance loss, fractures with extreme comminution, and unstable short oblique or transverse diaphyseal fractures. Plate fixation of phalangeal fractures is seldom necessary but helpful in treating segmental defects or extreme comminution of diaphysis or metaphysis as well as intraarticular T- or Y-condylar fractures. Screw and plate fixation at the metacarpal levels, when appropriately applied, renders rigid osteosynthesis while inflicting little to no interference on the surrounding soft tissues. Screws can be applied with little to no soft tissue interference throughout the proximal phalanx and proximal and distal aspects of the middle phalanx. Plate fixation for middle phalangeal fractures is limited to salvage situations for preservation of skeletal length. The essentials for successful use of implants are a hand surgeon well versed in a variety of internal fixation techniques including the association for the Study of Internal Fixation (ASIF) technique of screw and plate fixation, a meticulous respect for, and protection of, the soft tissues, and a facility for delivery of functional aftercare.- - - - - - - - - - ranking = 0.2keywords = seal (Clic here for more details about this article) |
15/28. Retardation of finger growth after injury to the flexor tendons.The absence of any part of the total mechanical force (i.e., flexor tendons) may be responsible for retardation of bone growth during a child's growth phase. The cause of retardation may be dedifferentiation of cartilage cells at the epiphyseal plate. Four cases in which unrepaired flexor tendons in digits caused retardation of growth illustrate this possible phenomenon. We feel that this is not a well recognized problem and thus deserves mention to stimulate further study. We believe that meticulous primary repair in children is desirable not only to preserve function, but also to prevent growth disturbances.- - - - - - - - - - ranking = 0.2keywords = seal (Clic here for more details about this article) |
16/28. Irreducible palmar dislocation of the proximal interphalangeal joint associated with an epiphyseal fracture of the middle phalanx.A palmar dislocation of the proximal interphalangeal joint that became irreducible because of a Salter-Harris type I fracture of the epiphysis of the middle phalanx is described. The anatomic mechanisms of irreducible palmar dislocations are discussed.- - - - - - - - - - ranking = 0.8keywords = seal (Clic here for more details about this article) |
17/28. hand fractures in children. A statistical analysis.A retrospective review of 354 pediatric hand fractures was performed with a minimum follow-up period of two years. The incidence of epiphyseal injury was 34% higher than reported elsewhere in the skeleton. Growth disturbance was extremely rare, occurring only in two patients with severe crush injury and infection. Fracture displacement was most common in the border digits with displacement within a given digit most common in the metacarpal; the next most common were the proximal phalanx and distal phalanges; the least common was the middle phalanx. Malunion most often was associated with failure to obtain adequate true lateral and anteroposterior roentgenograms of the individual digits, failure to evaluate postreduction alignment in a position of full finger flexion, and was based on an erroneous assumption that a growth would correct for deficient reduction. Although nondisplaced intra-articular fractures uniformly healed without malfunction, poor functional results were obtained from displaced intra-articular fractures. The following injuries presented particular problems: displaced intra-articular fractures, Salter I distal phalangeal fractures due to crushing injuries, displaced subcondylar fractures, and open fractures.- - - - - - - - - - ranking = 0.2keywords = seal (Clic here for more details about this article) |
18/28. An irreducible phalangeal epiphyseal fracture-dislocation. A case report.A 20-month-old infant sustained an irreducible epiphyseal fracture-dislocation of a proximal interphalangeal joint. The dorsal dislocation of the joint was associated with a 90 degree rotational displacement (Salter-Harris Type I fracture) of the epiphysis of the middle phalanx. This injury, which seems not to have been described previously, required open reduction through both volar and dorsal incisions because the intact collateral ligaments and extensor central slip did not permit adequate distraction of the joint.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
19/28. "Seal finger".Two young women developed septic arthritis in an interphalangeal joint following a seal bite. One patient was cured with tetracycline: the other required joint arthrodesis. This entity known as "seal finger" is common among sealers. Although the infection may be cured with tetracycline, in late treated or untreated cases joint destruction may occur. No causative organism has been isolated.- - - - - - - - - - ranking = 0.6keywords = seal (Clic here for more details about this article) |
20/28. Displaced epiphyseal plate of the terminal phalanx in a child.A case of mallet finger in a child is described. The epiphysis of the terminal phalanx was displaced dorsally with the extensor tendon attached to it, and was first diagnosed two weeks after injury. The treatment was by open reduction. Radiograph three years later showed that a satisfactory position of the epiphysis and normal growth of the terminal phalanx had occurred.- - - - - - - - - - ranking = 0.8keywords = seal (Clic here for more details about this article) |
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