Abstract
Background The difficulties in surgical treatment of pilon fractures of the finger include fragment
reconstitution and posthealing stiffness. In adults, external fixation with traction
and early active range of motion (AROM)/passive range of motion (PROM) during healing
is considered necessary for avoiding joint stiffness and attaining realignment. The
authors present a unique approach to pediatric pilon fractures that uses open reduction
and multivector external fixation with delayed AROM/PROM. Initial immobilization and
significant traction allowed for joint realignment and prevented noncompliance with
staged distraction. The authors believe this immobilization leads to a superior outcome
because, unlike adults, children tend to avoid stiffness and a larger distraction
force allowed for sufficient joint realignment to regain range of motion (ROM).
Methods A right-handed 13-year-old boy sustained a right ring finger fracture and presented
12 days later. Radiographs revealed a comminuted Salter-Harris 4 fracture of the middle
phalanx. The patient underwent open reduction and placement of multivector external
fixation using a pediatric mandibular distractor/fixator. Significant traction was
applied to distract the finger to length.
Results Hardware was removed 6 weeks postoperatively and AROM was initiated after splinting.
The patient started PROM 8 weeks postoperatively. Strengthening was initiated 2 weeks
later. ROM improved and rehabilitation was continued. The patient exhibited nearly
equal grip strength 12 weeks postoperatively. At 14 months follow-up, radiographs
showed complete healing and joint realignment. There was no deformity or pain and
finger length was restored.
Conclusion Management of pediatric pilon fractures is rarely described and presents unique considerations.
Early-stage traction and immobilization using a multivector mandibular fixator/distractor
is suitable in a child because noncompliance is avoided and there is a decreased risk
for stiffness. Combining early immobilization with subsequent-staged AROM, PROM, and
strengthening resulted in no loss of ROM and maintained articular symmetry.
Keywords
proximal interphalangeal joint - fracture - pilon fracture - pediatric hand - external
fixation - mandibular fixator
