Hand/Finger Fractures

Introduction

Finger and hand injuries are frequently encountered in children. Although lacerations and soft tissue injuries predominate, fractures represent 11.4% to 19.3% of pediatric hand injuries. In studies of pediatric fractures presenting to the emergency department, the hand is reported as the second most common site of fracture in children, with the fingers and carpals/metacarpals representing 14% to 15% and 7% to 13%, respectively, of fractures in patients aged 0–19 years old.

Most pediatric hand and finger fractures can be treated nonoperatively with a well-placed cast. Robust periosteum present in children provides support to nondisplaced or closed reduced fractures, and casting can be used with less concern for resultant stiffness than in the adult population. However, there are exceptions to this rule, with specific injury patterns at high risk for nonunion or malunion requiring operative intervention. The challenge for providers treating pediatric hand fractures is to first identify the injury and then appropriately determine course of treatment, as the severity of injury can be underestimated on initial evaluation. Attention to detail is imperative in treating these fractures to avoid complications.

Preoperatively

Preoperatively, the biggest pitfall in treating pediatric hand and finger fractures is a failure by the initial treating provider to recognize the presence or severity of the injury. Delay in diagnosis will subsequently result in delay of referral for orthopedic care. In pediatric patients, who typically benefit from a robust healing response, delay of care into even the second week from injury can make reduction and treatment very challenging.