Frequency, Pattern, and Treatment of Hand Fractures in Children and Adolescents: A 27-Year Review of 4356 Pediatric Hand Fractures

Abstract

Background: The frequency, pattern, and treatment of pediatric hand fractures are rarely reported. We sought to review our institution’s experience in the management of pediatric hand fractures. Methods: A retrospective review of children and adolescents (younger than 18 years) treated for hand fractures between January 1990 and June 2017 was preformed. Fractures were categorized into metacarpal, proximal/middle phalanx, distal phalanx, or intra-articular metacarpophalangeal (MCP)/proximal interphalangeal (PIP)/distal interphalangeal (DIP) fractures. Patients were categorized into 3 age groups (0-5, 6-11, and 12-17 years). Results: A total of 4356 patients were treated for hand fractures at a mean ± SD age of 12.2 ± 3.5 years. Most fractures occurred in patients aged 12 to 17 years (n = 2775, 64%), followed by patients aged 6 to 11 years (n = 1347, 31%). Only 234 (5%) fractures occurred in children younger than 5 years. Most fractures occurred in the proximal/middle phalanx (48%), followed by metacarpal (33%), distal phalangeal (12%), and intra-articular MCP/PIP/DIP joints (7%). Proximal/middle phalangeal fractures were the most common in all age groups. About 58% of intra-articular MCP/PIP/DIP fractures in patients aged between 0 and 5 years required open reduction ± fixation, and the remaining 42% fractures were amenable to closed reduction. In patients older than 5 years, about 70% of these fractures were amenable to closed reduction. All age groups included, most metacarpal (93%), proximal/middle phalangeal (92%), and distal phalangeal (86%) fractures were amenable to closed reduction alone. Conclusions: The frequency, pattern, and treatment of hand fractures vary among different age groups. Understanding the pattern of these fractures helps making the right diagnosis and guides choosing the appropriate treatment.

Distribution and pattern of hand fractures in children and adolescents

“…These results correspond well to previously published studies [3,5,6,8]. One of the largest cohorts was reported by Kreutz-Rodrigues and coworkers in 2020 including 4356 pediatric hand fractures; the authors found that almost half of the fractures occurred in the proximal/middle phalanx, but did neither separate these two bones nor report the affected ray in their statistical analysis [5]. Since this study reflects the epidemiological characteristics of the USA, the data is not consistent with the European findings in our investigation.…”

“…However, there is an ongoing discussion about the most commonly fractured bone of the child's Communicated by Piet Leroy hand [4]. The proximal phalanx seems to be the most frequently affected [5,6], but in younger children, distal tuft fractures can be even more common [7,8]. Moreover, pediatric hand fractures show a clear male predominance, except in toddlers [8] and are a domain of conservative fracture treatment [1,9].…”

Clinical characteristics and distribution of paediatric hand fractures at a tertiary hospital in South China: a retrospective analysis

“…Overall, these studies found that males are more vulnerable than females, older children are more likely to be injured, and the fifth finger and proximal phalanx are more frequently involved, which is similar to our results. In addition, eight out of nine studies reported a higher incidence of sports-related injuries than our series [3–5,7,9,18–20]; and Mirdad [8] reported that crushing is the most common aetiology of PHF. Different fracture characteristics among the studies are likely to be influenced by the different ages and types of activities, including sports, of patients.…”

Phalangeal and Metacarpal Fractures in Children: A 10-Year Comparison of Factors Affecting Functional Outcomes in 313 Patients

“… 6 7 Many fractures in children will only require a closed manipulation and splint. 8 Nevertheless, as in other locations, there is a limited capacity to remodel angular deformity and no capacity to remodel rotational deformity. 7 Operative fracture fixation, when used, is most commonly achieved through Kirschner (K-wire) insertion, which can be percutaneous or open, or open reduction internal fixation (ORIF) with a plate and screws or lag screws alone.…”