12/24/2022 0 Comments Buckle fracture![]() ![]() Younger children suffered more lacerations and burns and older children incurred more fractures, sprains, and sports injuries to the hand. Sixty percent of the injuries were sustained at home. The fifth finger was the most commonly fractured digit (37%), and the fifth metacarpal was the most commonly fractured bone. The authors found the most common injuries were lacerations (38.1%), soft-tissue injuries (28.7%), fractures (19.3%), and sprains (8%). 1Ī second retrospective study of hand injuries conducted in 1993, reported 464 patients with hand and wrist injuries during a six-month period in a pediatric ED. Infection occurred in 14 (3.7%) patients. The phalanges were the most commonly injured part of the hand, particularly the thumb (19%) fingertips were involved in 21% of cases. Only five patients required hospitalization (1.3%). Lacerations were the most common injury (30%), followed by fractures (16%). ![]() Of the reported 382 hand injuries, the majority were male (1.4:1), their median age was 10 years, and most injuries occurred outdoors (47%). This article will provide practical points related to the early identification, diagnosis, and treatment of pediatric hand and wrist injuries.Īlthough the exact number of children that sustain hand and wrist injuries is unknown, there have been many studies conducted in the United States and abroad during the past 10 years that provide valuable information regarding common mechanisms of injury, frequently sustained injury patterns, and injury patterns suspicious for abuse that may be of benefit in the care and treatment of the general pediatric population.Ī large urban pediatric emergency center in the United States reported 382 hand injuries in 17,859 patients seen during an eight-month period. It is critical that reliable pediatric referral patterns be developed from the ED with specialists who can promptly evaluate patients either in the ED or within an appropriate period of time and are comfortable in the management of the pediatric patient with an injured hand or wrist. Evaluation also is complicated by the unique aspects of pediatric bone growth and development and the small size of any affected area. The diagnosis of pediatric hand and wrist injuries is complicated because the patient’s history is often difficult to obtain, and the physical examination can be extremely challenging and limited. The severity may vary from minor damage to soft tissues to severely disfiguring and debilitating wounds. Pediatric hand and wrist injuries commonly are encountered in emergency medicine practice. The authors provide a comprehensive review of pediatric hand and wrist injuries with a special emphasis on the unique aspects of management. The small compact hand of the child, with many critical structures coursing through the wrist, hand, palm, and digits predisposes the child to injuring a significant underlying structure, such as a nerve or tendon, with a simple laceration therefore, lacerations of the hand deserve very thorough evaluations. Pediatric patients also frequently sustain injuries to their growth plates: Salter-Harris type fractures. In children, because the ligaments often are stronger than the underlying bone that is being connected, fractures more commonly will occur when typically a sprain would result in an adolescent or adult patient. Child abuse must be considered when atypical injuries are seen (e.g., circumferential burns, burns on the dorsum of the hand, incompatible history with injury). ![]() ![]() The history and physical examination may be challenging, but in the majority of situations are all that is needed to guide diagnostic imaging and management. A wide spectrum of injury occurs regardless of age-from the toddler exploring with his hands to the adolescent athlete falling on an outstretched hand. Pediatric hand and wrist injuries are an extremely common entity seen in every emergency department (ED) in the United States. Perron, MD, FACEP, FACSM, Residency Program Director, Maine Medical Center, Portland, ME Beeson, MD, MBA, FACEP, Professor of Clinical Emergency Medicine, Northeastern Ohio Universities College of Medicine Program Director, Department of Emergency Medicine, Summa Health System, Akron, OH Scooter Fractures, Buckle Fractures, and Beyond: Pediatric Hand and Wrist Injuries in the EDĪuthor: Michael S. ![]()
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