Salter-Harris Fractures of the Distal Phalanx: Treatment Algorithm and Surgical Outcomes

Waleed Gibreel, Ali Charafeddine, Brian T. Carlsen, Steven Lawrence Moran, Karim Bakri

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Salter-Harris fractures of the distal phalanx with or without clinical evidence of nail-bed laceration are frequently undertreated. METHODS: A retrospective review was performed of all patients with distal phalanx Salter-Harris fractures treated between 2004 and 2016. RESULTS: Seventy patients were treated for 72 Salter-Harris fractures at a mean ± SD age of 11.3 ± 3.7 years. Median follow-up was 6 weeks (interquartile range, 4 to 12.6 years). The thumb was most commonly involved (n = 21), followed by long (n = 18), ring (n =17), small (n = 9), and index (n = 7) fingers. Sport-related injuries accounted for 39 fractures (54 percent). Forty-two fractures (58 percent) had at least one clinical finding suggestive of nail-bed laceration (subungual hematoma, subluxation of the proximal nail plate, skin laceration proximal to the eponychial fold, bleeding from underneath the nail plate, eponychial fold laceration, and nail plate avulsion). Among 42 fractures with at least one feature of nail-bed laceration, surgical exploration was undertaken in 38 fractures. At exploration, a nail-bed laceration was found in 31 fractures (82 percent) and soft-tissue interposition was found in 18 (47 percent). Fractures with clinical features of nail-bed laceration (n = 42) were treated with open reduction and splinting (n = 25), open reduction and percutaneous pinning (n = 13), or splinting (n = 4). Excellent results were obtained, with few unfavorable outcomes. Infectious complications occurred in six patients. CONCLUSION: The high rate of nail-bed laceration and soft-tissue interposition in Salter-Harris fractures with clinical features of nail-bed laceration mandates surgical exploration. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Original languageEnglish (US)
Pages (from-to)720-729
Number of pages10
JournalPlastic and Reconstructive Surgery
Volume142
Issue number3
DOIs
StatePublished - Sep 1 2018

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Lacerations
Nails
Therapeutics
Salter-Harris Fractures
Athletic Injuries
Thumb
Hematoma
Fingers
Hemorrhage
Skin

ASJC Scopus subject areas

  • Surgery

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Salter-Harris Fractures of the Distal Phalanx : Treatment Algorithm and Surgical Outcomes. / Gibreel, Waleed; Charafeddine, Ali; Carlsen, Brian T.; Moran, Steven Lawrence; Bakri, Karim.

In: Plastic and Reconstructive Surgery, Vol. 142, No. 3, 01.09.2018, p. 720-729.

Research output: Contribution to journalArticle

Gibreel, Waleed ; Charafeddine, Ali ; Carlsen, Brian T. ; Moran, Steven Lawrence ; Bakri, Karim. / Salter-Harris Fractures of the Distal Phalanx : Treatment Algorithm and Surgical Outcomes. In: Plastic and Reconstructive Surgery. 2018 ; Vol. 142, No. 3. pp. 720-729.
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AB - BACKGROUND: Salter-Harris fractures of the distal phalanx with or without clinical evidence of nail-bed laceration are frequently undertreated. METHODS: A retrospective review was performed of all patients with distal phalanx Salter-Harris fractures treated between 2004 and 2016. RESULTS: Seventy patients were treated for 72 Salter-Harris fractures at a mean ± SD age of 11.3 ± 3.7 years. Median follow-up was 6 weeks (interquartile range, 4 to 12.6 years). The thumb was most commonly involved (n = 21), followed by long (n = 18), ring (n =17), small (n = 9), and index (n = 7) fingers. Sport-related injuries accounted for 39 fractures (54 percent). Forty-two fractures (58 percent) had at least one clinical finding suggestive of nail-bed laceration (subungual hematoma, subluxation of the proximal nail plate, skin laceration proximal to the eponychial fold, bleeding from underneath the nail plate, eponychial fold laceration, and nail plate avulsion). Among 42 fractures with at least one feature of nail-bed laceration, surgical exploration was undertaken in 38 fractures. At exploration, a nail-bed laceration was found in 31 fractures (82 percent) and soft-tissue interposition was found in 18 (47 percent). Fractures with clinical features of nail-bed laceration (n = 42) were treated with open reduction and splinting (n = 25), open reduction and percutaneous pinning (n = 13), or splinting (n = 4). Excellent results were obtained, with few unfavorable outcomes. Infectious complications occurred in six patients. CONCLUSION: The high rate of nail-bed laceration and soft-tissue interposition in Salter-Harris fractures with clinical features of nail-bed laceration mandates surgical exploration. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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