Surgical management of an open thumb fracture in a child

Abstract

Pediatric thumb fractures of the first metacarpal and/or proximal and/or distal phalanx are rare and most commonly treated conservatively. Surgery is preferred in patients with intraarticular fractures or when closed reduction cannot be achieved. In cases of comminuted open fractures, surgical treatment is also recommended. Dorsolateral, volar, or midlateral approach may be conducted, respecting the tendons, sheaths, and neurovascular structures. In this study, we describe an unusual case of a boy with a comminuted open fracture of the proximal phalanx of his left thumb. Due to extended soft tissue injury and severe swelling, surgery was performed in a late fashion, through the extensor mechanism of the thumb.