Hand and wrist fractures have been consistently reported as among the most common fractures in children. 1-3 They are 3 times more common in boys and peak in the teenage years (Fig. 1). 4 Forearm fractures compromise the largest proportion of fractures. 1 In the hand, the proximal phalanx and the fifth ray are the most commonly affected bone and digit, respectively (Fig. 2). 4 Distal phalangeal fractures tend to occur in toddlers starting to explore the world with their hands, making them susceptible to fingertip crush injuries from slammed doors. With increasing age, the distribution of fractures moves proximally, with median ages of 12 years for proximal phalanx fractures and 15 years for metacarpal fractures. This distribution corresponds to the increasing body weight and participation in sporting activities during the teenage years. CONSIDERATIONS IN THE PEDIATRIC POPULATION Epidemiologic studies generally use 17 years or 18 years of age as the limit for pediatric fractures. The unique considerations in the management of pediatric hand fractures, however, apply to children with open physes with the potential to remodel. In addition, the ability of a child to participate and cooperate in the management may Disclosure: The authors have nothing to disclose.

Progressive tendon adhesion is a major challenge in flexor tendon repair. The authors developed a bifunctional anti-adhesion scaffold and hypothesized that its application would reduce adhesion formation and deliver mesenchymal stem cells (MSCs) to enhance tendon healing. The scaffold was fabricated by an electrospinning machine before surface modification. The flexor tendons of 29 New Zealand rabbits underwent surgical repair and randomized to control, scaffold and scaffold loaded with MSC group. At 3 and 8 weeks post-surgery, range of motion (ROM), biomechanical properties, and histology were examined. There was no significant increase in ROM and biomechanical properties between the three groups. The histology showed successful delivery of MSCs but no significant difference in nuclear morphometry. This barrier delivers and retains MSCs within the tendon repair site. However, its sheet form and wrapping around the repair site may not be optimal for tendon healing. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2605-2614, 2018.

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Background: Phalangeal neck fractures account for 13% of pediatric finger fractures. Al Qattan type I (undisplaced) fractures are treated nonoperatively. There is increasing evidence that Type 2 (displaced) fractures achieve remarkable fracture remodeling with nonoperative treatment and patients frequently make a full functional recovery. The options available for nonoperative management of these fractures are either a plaster cast or a removable splint. We hypothesized that there would be no significant difference in radiologic outcome in pediatric phalangeal neck fractures (Types I and II) treated with splint or cast immobilization. Methods: This is a retrospective study of patients aged 18 and below with phalangeal neck fractures treated nonoperatively from 2008 to 2017. Radiographs were compared at <1 week and >3 weeks after injury. Translation and angulation in coronal and sagittal planes were measured and compared using Student t tests. Baseline variables were compared using χ2 or Fisher exact tests. Results: There were 47 patients with phalangeal neck fractures treated nonoperatively during the study period. There were 9 type I and 38 type II fractures. The mean age was 10 years with 40 males and 7 females. Fractures occurred in 33 dominant and 14 nondominant hands and involved 29 proximal and 18 middle phalanges. Nineteen children were treated in casts and 28 with removable splints. The mean duration of follow-up was similar between the 2 groups. The most affected phalanx was the proximal phalanx of the small finger and the most common fracture pattern was type IIA. There was no significant difference in clinical and radiologic outcomes between children who were treated in casts and those treated in removable splints. Conclusion: There was no difference in the clinical and radiologic outcomes in pediatric phalangeal neck fractures treated with cast or splint immobilization. Splinting has the added benefits of increased comfort and hygiene and we routinely offer splinting as a viable alternative in the nonoperative treatment of Al Qattan type I and type II phalangeal fractures. Type of Study/Level of Evidence: Level III—therapeutic studies.