The Epidemiology of Operative Pediatric Hand Trauma: A Retrospective Chart Review

Abstract

Background: Hand injuries are common in the pediatric population with a wide spectrum of morbidity that can occur. Simple injuries are distinguished from complex injuries by the number of fingers/systems that are involved. The epidemiology of simple and complex operative hand trauma in the pediatric population has not yet been defined. Methods: A retrospective review was performed of all pediatric patients requiring operative intervention for hand trauma at a major children’s hospital over a 3-year period (2015-2017). Data pertaining to demographics, mechanism, severity, type of surgery, and other factors related to hand trauma were then analyzed and interpreted. Results: Three hundred seventy-one pediatric hand injuries over a 3-year period required surgical intervention, with 19.2% being classified as complex. The average patient age was 11.0 years. A total of 68.7% of patients were men. Bony injuries made up 86.3% of simple injuries, with the proximal phalanx being the most commonly fractured bone. Complex injuries occurred more frequently in men and required a greater number of surgeries (1.6 vs 1.0). Of the complex injuries, only major injuries (severity score >100) required a significantly greater number of surgeries. Major hand injuries were mostly caused by motorized vehicles and required a significantly greater number of surgeries (3.8), compared with other causes of injuries. Conclusions: Operative hand injuries occur along a spectrum of morbidity in the pediatric population. While most of the injuries are simple and require only 1 procedure, more complex injuries can also occur and deserve a higher level of care and attention.

Operative Pediatric Hand Trauma

“…However, the incidence of metacarpal fractures was expressively lower than reported in other studies. 1 , 2 , 9 Among the phalanges, the distal phalanx was more vulnerable to fracture for all age groups (53.4%), in contrast to other studies who presented the proximal phalanx as the most commonly fractured bone. 1 , 8 , 9 , 11 …”

“…Tendons injuries were identified in 27.7% of the cases, a percentage superior to the 4.7% and 9.4% described by Koshy 1 and Voth 2 respectively. Besides, the flexor tendons were injured in 60.5%, differing from the literature.…”

“…Hand injuries account for almost 20% of childhood injuries, with a wide spectrum of morbidity. 1 , 2 Hand fractures are the second most common fracture in children, 3 representing up to 25% of all limb fractures. 2…”

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

“…Middle phalanx fractures are the 3 rd most common hand fracture in the pediatric population. 1 They reported one of their fractures was irreducible due to entrapment of the flexor tendons which was subsequently treated with Kirschner-wire fixation.…”

“…In the pediatric population, phalangeal fractures represent the most common type of hand fracture, with middle phalanx fractures comprising 16%of all hand fractures. 1 Salter-Harris type II fractures are the most common type of finger fracture pattern in the pediatric population. 2,3 Management of phalangeal fractures is based on the initial severity of injury and depends on the success of closed reduction techniques.…”