It seemed like a typical childhood accident. He was taken to an emergency care facility, where the fracture was reduced and treated non-surgically. To the family, the problem appeared to be resolved.
But eight days later, his mother noticed something was wrong. The cast had gotten wet, and the finger still looked concerning. That was when she sought out the Rio Hand Experts team for a second opinion.
The diagnosis
During the consultation, we did not rely solely on X-rays. We assessed the stability of the injury, the alignment of the finger, and the stage of fracture healing. There was another important factor: Lucas has Autism Spectrum Disorder (ASD), support level 2, which required an individualized approach at every stage of care.
The imaging revealed a fracture of the proximal phalanx neck of the little finger, classified as Al-Qattan type IIb. This is an inherently unstable injury with a high risk of loss of reduction.
The new X-rays confirmed exactly this scenario: the initial reduction had been lost, and the fracture was already showing advanced signs of healing.
The treatment
The decision to proceed with surgery was not based solely on the observed misalignment. Fractures of the phalangeal neck are located far from the growth plate and have limited capacity for spontaneous remodeling. In other words, waiting for the bone to correct the deformity on its own could have resulted in permanent limitations on movement and function.
Surgical planning also required special attention due to the child's behavioral profile. From the very first interaction, the entire team had to adapt their approach to minimize stimuli and gradually gain the child's trust. Anesthesia induction itself posed a significant challenge, as the patient would not even tolerate venipuncture.
Despite the fracture already being in the process of healing, it was possible to perform a closed reduction without needing to make an incision in the finger.
Using a "joystick" technique with a Kirschner wire inserted directly into the fracture site, the team was able to manipulate the bone fragment, restore the anatomy of the phalangeal neck, and stabilize the injury percutaneously.
The surgery
It was a technically demanding surgery. The small size of the bone fragments, the patient's age, and the location on the little finger significantly increased the procedure's level of difficulty.
The recovery
The recovery progressed satisfactorily, preserving joint alignment and creating the necessary conditions for Lucas to return to his activities without the limitations that the deformity could have caused in the future.
What this case teaches
Not every hand fracture in childhood is simple. Some injuries exhibit inherent instability and require close monitoring, even after an initially satisfactory reduction. Early recognition of signs of treatment failure and an understanding of each fracture's remodeling potential can make all the difference in the final outcome.
— Dr. Rodrigo Berlink and Dr. André Eiras
If conservative treatment has been recommended for a hand fracture and you have questions about the course of recovery, a specialist evaluation can help determine the best path forward.
