Open osteochondral fracture of the distal phalanx tuft in young children’s fingertip: a frequently non-diagnosed injury

Abstract

The hand is the region of the body most affected by trauma in children. Crushing trauma to the fingertip often occurs in young children. Often, in the emergency department, little importance is given to the correct treatment of these injuries, often leaving important sequelae. In young children, less than four years of age, the proximal epiphysis of the distal phalanx is not calcified, so it is not visible on radiographs. Also, the calcified portion of the phalanx is much smaller. In this age group, proportionally, compared to older children, the fingertip is formed and supported more by soft tissues (pulp) and by cartilage, since the phalanx is covered over its entire surface by a chondral cap. Thus, at this stage, during a crush injury, with flexion of the distal portion of the fingertip (a mechanism like Seymour’s fracture), the most fragile region is the osteochondral junction of the phalanx tuft. This results in a detached nail plate injury, sterile nail matrix injury, and skin laceration with exposed bone and osteochondral fracture. Our objective is to describe this type of fingertip crush injury in young children, with exposed osteochondral fracture associated with damage to the nail matrix, and his treatment. This injury is an open fracture that compromises the distal osteochondral junction, behaving very similarly to the Seymour fracture that is located proximally in the phalanx. We want to draw attention to the fact that the generalized idea that injuries in children evolve well, despite the severity and regardless of the treatment carried out, is wrong in many cases.