Published: 2020-08-26

Salter-Harris type II fracture of the middle phalanx with concomitant central slip injury in an 11 year old: a case report

Devan O. Higginbotham, Andrew G. Tsai


An 11-year-old male sustained an irreducible, completely displaced epiphyseal fracture of the proximal interphalangeal joint (PIPJ) of the middle finger with an associated central slip injury. Central slip injuries occurring in conjunction with Salter-Harris type II middle phalanx fracture are rare entities, with no previously documented case. Our patient underwent open reduction, internal fixation through crossed-pins to achieve reduction and fixation. He was then splinted in extension for six weeks to allow healing of the central slip injury. At 1-year follow-up, the patient had full range-of-motion with no clinical indication of physeal disruption or growth arrest of the repaired digit. We demonstrate a case in which ephiphyseal fractures of the proximal interphalangeal joint with a concomitant central slip injury can safely be treated with open reduction internal fixation combined with a period of immobilization. We characterize a surgical method of reduction and fixation with splinted immobilization and describe lessons learned from this previously unreported case.


Central slip, Phalanx fracture, Epiphysis, Hand, Trauma

Full Text:



Koshy JC, Grome LJ, Schultz K, Bell B, Reece E, Pederson WC. The epidemiology of operative pediatric hand trauma: A retrospective chart review. Hand (N Y) 2019.

Abzug JM, Dua K, Bauer AS, Cornwall R, Wyrick TO. Pediatric phalanx fractures. J Am Acad Orthop Surg 2016;24:174-83.

Vadivelu R, Dias JJ, Burke FD, Stanton J: Hand injuries in children. J Pediatr Orthop 2006;26(1):29-35.

Liss FE, Green SM: Capsular injuries of the proximal interphalangeal joint. Hand Clin 1992;8(4):755-68.

Boussakri H, Azarkane M, Dahmani O, Elidrissi M, Shimi M, Elibrahimi A, Elmrini A. Unusual combinations of lesions of the traumatic hand: Closed central slip laceration of the extensor and interphalangeal thumb joint’s dislocation (A case report). Pan Afr Med J 2014;18:230.

Boyer JS, London DA, Stepan JG, Goldfarb CA. Pediatric proximal phalanx fractures. Outcomes and complications after the surgical treatment of displaced fractures. J Pediatr Orthop 2015;35(3):219-23.

Hamilton LC. The acute management of unstable intra-articular fractures of the base of the middle phalanx: A systemic review. J Hand Surg Asian Pac 2018;23(4):441-9.

Al-Qattan MM. Juxta-epiphyseal fractures at the bof the proximal phalanx of the fingers in children and adolescents. J Hand Surg Br 2002;27(1):24-30.

Cornwall R, Ricchetti ET. Pediatric phalanx fractures: Unique challenges and pitfalls. Clin Orthop Relat Res 2006;445:146-56.

Spinner M, Choi BY. Anterior dislocation of the proximal interphalangeal joint. J Bone Joint Surg [Am] 1970;52:1329-36.

Jones NF, Jupiter JB. Irreducible palmar dislocation of the proximal interphalangeal joint associated with an epiphyseal fracture of the middle phalanx. J Hand Surg Am 1985;10(2):261-4.

Pratt AL, Burr N, Grobelaar AO. A prospective review of open central slip laceration repair and rehabilitation. Journal of Hand Surgery (British and European Volume) 2002;27B(6):530-4.