Operative Carpal and Hand Injuries in Children

Abstract

Most carpal and hand injuries in children are treated nonoperatively. The purpose of this lecture is to identify those clinical situations that require operative intervention. Complications from pediatric hand fractures, dislocations, and soft-tissue injuries are most commonly due to the failure to identify and treat an injury requiring an operation acutely. This lecture will also review surgical techniques for specific injuries of the carpus and hand in children. With regard to the wrist, this discussion will include the indications for open reduction of scaphoid fractures, treatment of scaphoid nonunions, and arthroscopic examination and treatment of chondral and ligamentous injuries. Distal injuries that are treated surgically include Seymour fractures, phalangeal neck injuries, and intra-articular fractures. Look for this and other related articles in Instructional Course Lectures , Volume 57, which will be published by the American Academy of Orthopaedic Surgeons in March 2008: • “Surgical Management of Forearm and Distal Radius Fractures in Children and Adolescents,” by Charles T. Price, MD A scaphoid fracture is the most common carpal injury in children, and it has become more common during the last decade or two1-3. The increased participation in competitive youth sports may account for the increased incidence of these fractures. As in adults, scaphoid fractures are classified by the location, degree, and direction of fracture displacement. Distal pole, waist, and proximal fractures all occur in children, with waist fractures being the most common4,5. As in adults, displacement beyond 1 to 2 mm is associated with malunion or nonunion in children6. Determining the amount of displacement can be difficult, and computed tomography or magnetic resonance imaging is an important evaluation for this purpose and can be of help as a guide in the treatment of these fractures7-10. Osteonecrosis …