10 Pediatric Hand Fractures

Abstract

SummaryPediatric hand fractures are common childhood injuries. Identification of the fractures in the emergency room setting can be challenging owing to the physes and incomplete ossification of the carpus that are not revealed in the xrays. Most simple fractures can be treated with appropriate immobilization through buddy taping, finger splints, or casting. If correctly diagnosed, reduced and immobilized, these fractures usually result in excellent clinical outcomes. However, fractures may require operative stabilization if they have substantial angulation or rotation, extend into the joint, or cannot be held in a reduced position with splinting alone. Most fractures can be treated operatively with closed reduction and percutaneous pinning if addressed within the first week following the injury. In children, the thick, vascular-rich periosteum and bony remodeling potential make anatomic reductions and internal fixation rarely necessary. Most fractures complete bony healing in 3-4 weeks, with the scaphoid being a notable exception. Following immobilization, children rarely develop hand stiffness and formal occupational therapy is usually not necessary. Despite the high potential for excellent outcomes in pediatric hand fractures, some fractures remain difficult to diagnose and treat. Keywords Pediatric hand fractures; Pediatric hand injuriesA number of pediatric hand fractures have fairly innocuous presentations, but require early recognition and intervention to achieve satisfactory outcomes. Seymour fractures (open distal phalanx physeal fracture with proximal nail fold incarceration) must be identified and treated operatively to avoid infection, malunion, and nail deformities. Distal condylar phalangeal (DCP) fractures are difficult to address if not reduced at the time of injury. An osteotomy to correct a DCP malunion can be fraught with complications, and sagittal plane deformities may be able to remodel better than previously thought. Scaphoid waist fractures in adolescents, if not identified shortly after injury and immobilized appropriately, may result in non-union.