Key takeaways
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There’s a lack of extensive research on optimal treatment and outcomes for pediatric proximal phalanx base fractures.
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This study found that most of these common finger fractures healed successfully with non-surgical methods like immobilization.
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Closed reduction was the most effective treatment approach for fractures with greater than 10 degrees of coronal angulation.
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Surgery, although rarely required, was most effective for severe displacement, rotational deformity or failure to maintain reduction.
Research study background
Hand injuries, particularly finger fractures, are common in children. Extra-articular, juxtaphyseal fractures of the proximal phalanx — a fracture near the growth plate of the first bone segment in the finger but not within the joint itself — are the most frequent type to occur in this population. While most fractures can be managed non-surgically with early immobilization, timely evaluation and understanding of fracture characteristics are essential for optimal outcomes. Despite their prevalence, published data on treatment decisions and long-term results remain limited for these fractures.
This retrospective study, designed and lead by pediatric hand surgery experts at Children’s Hospital Colorado, is the team’s third published study in collaboration with Children’s Mercy Hospital. It sought to investigate post-treatment outcomes for these types of fractures and identify radiographic parameters that may help guide treatment decisions. The two sites reviewed charts of patients treated between 2002 and 2019 with a total of 634 fractures. These patients were evaluated for outcomes and categorized into three groups by treatment type: no reduction (the fracture is immobilized without realignment), closed reduction (the fracture is realigned without surgery) and surgical intervention. They found that the majority of these fractures (74.3%) were managed without reduction and 23.5% received non-operative closed reduction. Only 2.2% required any type of surgical management.
Study authors also assessed the average radiographic change within each group between initial and final radiographs. They observed significant decreases in angulation in the closed reduction and surgical groups, at 11.8 degrees for closed reduction and 19 degrees for surgery. The mean coronal angulation value after closed reduction was 6.1 degrees, ultimately measuring 5.8 degrees after immobilization at the final follow-up. Among all treatment groups, rotational misalignment (scissoring of the fingers) was rare with an overall occurrence rate of 0.93%.
Clinical implications
Overall, most of these fractures were successfully treated within the emergency department or clinic without surgery, through immobilization (with or without reduction), and healed without compromising the range of motion. When surgery was required, the team noted that it was associated with delayed presentation, rotational deformity after closed reduction, displacement greater than 1.5 mm and loss of fracture reduction at early follow-up.
Radiologic data from the study lent insight on potential treatment parameters to improve outcomes. Closed reduction seemed to be most effective for fractures with greater than 10 degrees of coronal angulation. The best non-surgical results were achieved when fractures were realigned within five degrees of the coronal and sagittal planes. While not a definitive surgical indication, surgery appeared to be most effective for fractures that were severely displaced or angulated. Future research should explore whether a child’s age affects the degree of residual angulation that can be tolerated during remodeling.
Featured researchers

Sarah Sibbel, MD
Director of Pediatric Hand and Upper Extremity Program
The Orthopedics Institute
Children's Hospital Colorado
Associate professor
Orthopedics
University of Colorado School of Medicine
Andy Lalka, MPH
Orthopedics, Pediatric Hand & Upper Extremity Program
Children’s Hospital Colorado
Sr. Professional Research Assistant
Orthopedics, Pediatric Hand & Upper Extremity Program
University of Colorado School of Medicine