“One Note Higher”: A Unique Pediatric Hand Fracture

Case Presentation: An otherwise healthy, 12-year-old male presented to the emergency department after a fall down the stairs in which he landed on his right hand. Radiographs demonstrated a Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation, also kn...

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Main Authors: Scott Szymanski, Michael Zylstra, Aicha Hull
Format: Article
Language:English
Published: eScholarship Publishing, University of California 2021-05-01
Series:Clinical Practice and Cases in Emergency Medicine
Online Access:https://escholarship.org/uc/item/0ww8q29n
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spelling doaj-9dec5e7116d749628ceb8486f56184aa2021-05-24T21:03:03ZengeScholarship Publishing, University of CaliforniaClinical Practice and Cases in Emergency Medicine2474-252X2021-05-015210.5811/cpcem.2021.3.51806cpcem-05-270“One Note Higher”: A Unique Pediatric Hand FractureScott SzymanskiMichael ZylstraAicha HullCase Presentation: An otherwise healthy, 12-year-old male presented to the emergency department after a fall down the stairs in which he landed on his right hand. Radiographs demonstrated a Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation, also known as an “extra-octave“ fracture. Orthopedic surgery was consulted and the fracture was reduced and placed in a short-arm cast. The patient was discharged and scheduled for orthopedic follow-up. Discussion: A Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation is referred to as an “extra-octave” fracture due to the advantage a pianist would gain in reach of their fifth phalanx if not reduced. However, reduction is needed if the fracture is displaced and can be achieved by several described methods including the “90-90” or “pencil” methods followed by cast or splint application. Percutaneous pinning is rarely needed. Complications include flexor tendon entrapment, collateral ligament disruption, and malunion leading to a “pseudo-claw” deformity. We recommend that all extra-octave fractures receive orthopedic follow-up in one to two weeks or sooner if severely displaced.https://escholarship.org/uc/item/0ww8q29n
collection DOAJ
language English
format Article
sources DOAJ
author Scott Szymanski
Michael Zylstra
Aicha Hull
spellingShingle Scott Szymanski
Michael Zylstra
Aicha Hull
“One Note Higher”: A Unique Pediatric Hand Fracture
Clinical Practice and Cases in Emergency Medicine
author_facet Scott Szymanski
Michael Zylstra
Aicha Hull
author_sort Scott Szymanski
title “One Note Higher”: A Unique Pediatric Hand Fracture
title_short “One Note Higher”: A Unique Pediatric Hand Fracture
title_full “One Note Higher”: A Unique Pediatric Hand Fracture
title_fullStr “One Note Higher”: A Unique Pediatric Hand Fracture
title_full_unstemmed “One Note Higher”: A Unique Pediatric Hand Fracture
title_sort “one note higher”: a unique pediatric hand fracture
publisher eScholarship Publishing, University of California
series Clinical Practice and Cases in Emergency Medicine
issn 2474-252X
publishDate 2021-05-01
description Case Presentation: An otherwise healthy, 12-year-old male presented to the emergency department after a fall down the stairs in which he landed on his right hand. Radiographs demonstrated a Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation, also known as an “extra-octave“ fracture. Orthopedic surgery was consulted and the fracture was reduced and placed in a short-arm cast. The patient was discharged and scheduled for orthopedic follow-up. Discussion: A Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation is referred to as an “extra-octave” fracture due to the advantage a pianist would gain in reach of their fifth phalanx if not reduced. However, reduction is needed if the fracture is displaced and can be achieved by several described methods including the “90-90” or “pencil” methods followed by cast or splint application. Percutaneous pinning is rarely needed. Complications include flexor tendon entrapment, collateral ligament disruption, and malunion leading to a “pseudo-claw” deformity. We recommend that all extra-octave fractures receive orthopedic follow-up in one to two weeks or sooner if severely displaced.
url https://escholarship.org/uc/item/0ww8q29n
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