Nonunion following subcapital (neck) fractures of the proximal phalanx of the thumb in children

Six cases of nonunion of subcapital (neck) fractures of the proximal phalan x of the thumb in children were seen over a period of 5 years. Ages at the time of injury ranged between 2 and 3 years. Entrapment of the thumb in a c losing door was the mechanism of injury in all cases. All fractures were cl osed and mere significantly displaced. Immediate management was by dosed re duction and splinting in four cases, closed reduction and K-mire fixation i n one case and no treatment in one case, which was later treated by delayed open reduction and K-wire fixation. Only two of the six ununited fractures were eventually treated with bone grafts and both fractures united resulti ng in a stable thumb but with a limited range of flexion of the interphalan geal joint. Factors that may increase the risk of nonunion of these fractur es in children are discussed.