BACKGROUND: Phalanx fractures are the most common pediatric hand fracture typically resulting from a crush or traumatic event such as a fall. A Salter-Harris Type II fracture involves a fracture extending through the physeal plate (growth plate) of a bone proximally through the metaphysis. METHODS: An 11-year-old African American female gymnast with 1 year of competitive cheer was performing a back tuck on the trampoline when another person jumped on the trampoline causing her to lose balance and land forward causing a direct impact of her right third distal phalanx on the trampoline while trying to catch herself. She initially reported pain feeling like her finger was “jammed” and unable to move her finger. Initial observation revealedan obvious lateral deviation of the distal phalanx and edema at the metacarpophalangeal joint (MCP joint). She was immediately treated with ice and then transported to the Emergency room (ER) 45 minutes later. X-ray revealed a Salter-Harris Type II Fracture in the proximal phalanx of the right third phalanx with a buckle deformity in the metaphysis and widening of the physis without a dislocation. Following diagnosis, the patient was given hydrocodone for pain and her fingers were buddy taped for stability and referred to an Orthopedist. Two days after initial injury the orthopedist suggested surgical intervention to correct the deformity, in which they placed an internal fixation of the proximal phalanx to close the physis. After surgery her hand was placed in a heavy bandage with instructions to return for a post-op visit 13 days later. RESULTS: Immediately following the surgery, she had trouble writing, as the injury affected her dominant hand, but subsided after one-week. She did not complete any rehabilitation and was not permitted to get the hand wet until her follow-up appointment. Initial projected recovery was four-six weeks. At the patients’ three-week follow-up, the orthopedic surgeon stated healing was sufficient and the physician approved return to activity as long as she didn’t have pain. CONCLUSION: Finger injuries are common in sports and typically follow a conservative treatment (casting or splinting). However, surgery was recommended due to the age of the patient, involvement of the physeal plate and obvious gross deformity present. Finger injuries are often overlooked as insignificant; however, clinicians should take extreme care to evaluate the best course of treatment to avoid poor outcomes and potential debilitating long-term consequences.

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