Salter II fractures predominate (Fig.
6). In the young child, after fingertip injury, the most common
hand fracture is a fracture of the proximal phalanx base with ulnar
or radial angulation. If seen within the first two days, the fracture usually
can be reduced with a local block, using a pencil or the examiner's finger
in the web space as a fulcrum (Fig. 6).
A less common pattern is the pediatric mallet fracture, in which a portion
or the entire growth plate is translated dorsal relative to the remainder
of the distal phalanx (Fig. 17).
This fracture is unstable, and temporary Kirschner wire fixation is reasonable.
In the older male pre-adolescent, boxer's fracture (Fig.
7) becomes more common. This may be Salter II, but more often is
metaphyseal, and in either case is treated as an adult boxer's fracture.
Mallet fracture and profundus avulsion fractures are discussed in the section below covering closed tendon ruptures.