bones-icon
2nd opinion for my son's finger fracture
Hello Doctor, I need a second opinion for my 2.5-year-old son’s right middle finger injury. About 10–15 days ago, his finger was severely crushed in a door, causing significant soft tissue loss and a fracture. We first saw an orthopedic doctor, who referred us to a surgeon for wound care. After dressings, another surgeon advised waiting for the wound to heal before deciding on surgery, mentioning the fingertip might remain slightly bent. Now the wound has mostly healed, and a repeat X-ray shows the bone is displaced. The orthopedic surgeon now recommends surgery under anesthesia with K-wire (pin) fixation. I have attached the latest X-rays. Is surgery/K-wire really necessary, or can it heal well without surgery considering his age? Is it safe and appropriate to operate 10–15 days after the injury? What would you recommend? Thank you.
26 Views v

Answers (5)

20000+ health queries resolved in last month
Care AI Shimmer
You can leave it as such Repeat xray after 1 month of injury, than decide
Answered
Flag this Answer
Flag this answer
Let others know if this answer was helpful
Was this answer helpful?
In a 2½-year-old child, a stable, minimally displaced fingertip fracture can often heal with dressings and splinting. However, young age does not guarantee correction when the fracture is markedly displaced, rotated, unstable, involves the growth plate, or has tissue trapped between the bone ends. A crush injury with nail-bed disruption may represent an open distal-phalanx injury such as a Seymour-type fracture; these require careful washout, reduction, nail-bed treatment and antibiotics because inadequate treatment can cause infection, growth disturbance, persistent bending or nail deformity. K-wire fixation is usually recommended when the fracture cannot be adequately reduced or will not remain stable in a splint. If satisfactory alignment can be achieved and maintained without a pin, non-operative treatment may still be possible. Therefore, the decision should be based on proper AP, lateral and oblique X-rays, examination of finger alignment and circulation, and assessment of the nail bed and wound—not only on the child’s age. Operating 10–15 days after injury is not automatically too late or unsafe. Delayed pediatric fingertip fractures are treated surgically when necessary, although reduction can become more difficult as healing begins, and the surgeon must carefully check for infection.
Next Steps
If the fracture is significantly displaced or unstable, or the growth plate/nail bed is involved, reduction and temporary K-wire fixation is a reasonable recommendation. Seek urgent review for pus, foul smell, fever, increasing redness/swelling, worsening pain, blackening or poor circulation of the fingertip
Answered
Flag this Answer
Flag this answer
Let others know if this answer was helpful
Was this answer helpful?
Get in person consult for better evaluation and management
Answered
Flag this Answer
Flag this answer
Let others know if this answer was helpful
Was this answer helpful?
Share a clear X rays images please
Answered
Flag this Answer
Flag this answer
Let others know if this answer was helpful
Was this answer helpful?
The fracture may heal without kwire but the soft tissue looks quite compromised. It may need a flap or some other soft tissue surgery. You can also consult a plastic surgeon for further opinion
Answered
Flag this Answer
Flag this answer
0/1 people found this helpful
Was this answer helpful?
Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.