Pediatric Hand Fractures

Abstract

Summary Pediatric 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.

Buddy taping versus splint immobilization for paediatric finger fractures: a randomized controlled trial

“…The aim of immobilization is not only to prevent secondary displacement but to provide sufficient analgesia. Some authors have therefore recommended supplementing taping with a gutter or rigid splint in unstable, particularly oblique or spiral fractures (Nellans and Chung, 2013). We extended our indication to taping (without a further splint) to fractures that were considered unstable due to the oblique fracture type, multiple fragments or after reduction, without experiencing an increase in the rate of secondary displacement.…”

“…In standard textbooks, the indication has been extended in recent years to treat most undisplaced, stable fractures of all phalanges of the index to little finger with buddy taping (Day, 2016). Specific recommendations for children and adolescents were given by Nellans and Chung, who recommended buddy taping as an effective treatment for length-stable fractures with minimal displacement (Nellans and Chung, 2013).…”

National Trends in Carpal Tunnel Release and Hand Fracture Procedures Performed During Orthopaedic Residency: An Analysis of ACGME Case Logs

“…Children aged 5 to 14 have a hand fracture incidence of 546 per 100 000, and comprise a reported 2.3% of all emergency room visits. 16,17 Although the high incidence of pediatric hand fractures does not necessarily translate to increased operative case volume, the minimal caseload revealed in our study (3.5 cases per graduating resident) suggests a relative paucity of operative pediatric hand fracture experience among residents. Nonetheless, our study did demonstrate a statistically significant increase in pediatric hand fracture case volume.…”

Phalangeal fractures in children

“…Većina ovih prijeloma može se liječiti konzervativnim mjerama, i to sa šest do osam tjedana kontinuirane imobilizacije za distalni interfalangealni (DIP) zglob, uz dodatna dva do četiri tjedna istovrsne imobilizacije tijekom noći i tijekom športskih aktivnosti (15). U slučaju trajne volarne subluksacije distalne u odnosu na srednju falangu (Slika 2), kad zglobni fragment zahvaća više od 50% zglobne površine i kod bolesnika koji su nesuradljivi za imobilizaciju, operativnom liječenju treba dati prednost u odnosu na konzervativno (16). U suprotnom, postoji značajan rizik za deficit ekstenzije, nestabilnost DIP zgloba i razvoj swan neck deformiteta (17).…”

“…Subkapitalni ili prijelom vrata članka prsta nastaje distalno od recesusa za kolateralni ligament u području srednjeg ili proksimalnog članka (16). Ovaj se prijelom smatra nestabilnim u sagitalnoj ravnini zato što dolazi do dorzalne dislokacije distalnog fragmenta, zbog čega nastaje obliteracija subkondilarne fose te posljedična nemogućnost fleksije interfalangealnog zgloba (9).…”