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What is a Pediatric Hand and Wrist Fracture?

Pediatric Hand and wrist fractures are breaks or cracks in the hand and wrist bones in children. These are more common in boys and in teenage children. 

Incidence of Pediatric Hand and Wrist Fractures

Distal phalangeal fractures, which are fractures of the fingertip, tend to occur in toddlers starting to explore the world with their hands, making them susceptible to fingertip crush injuries from slammed doors. 

As age increases, the fracture risk is lessened in children. Proximal phalanx fractures are more common at the age of 12 and metacarpal fractures at 15. This distribution corresponds to the increasing body weight and participation in sporting activities during this phase of an adolescent’s life.

Causes of Pediatric Hand and Wrist Fractures

Hand and wrist injuries in children can happen for the following reasons:

  • A child falls on an outstretched hand 
  • Direct trauma to the hand and wrist 
  • Hyperextension of hand and wrist
  • Jamming injuries that cause compression of hand and wrist bones

Symptoms of Pediatric Hand and Wrist Fractures

Symptoms of a pediatric hand and wrist fractures may include:

  • Acute and severe pain 
  • Tenderness
  • Swelling and bruising
  • Stiffness in the wrist
  • Tingling and numbness
  • Warmth and redness near the affected area
  • Dislocated or crooked appearance, or abnormal position of the hand and wrist
  • Difficulty moving the wrist and hand

Complications of Pediatric Hand and Wrist Fractures

Complications of pediatric hand and wrist fractures include:

  • Improper nail growth. 
  • An extensor lag (lack of full extension) of up to 10 degrees, even when the fracture is treated properly.  
  • Malunion or non-union of the bones
  • Infection
  • Osteomyelitis
  • Joint contracture

Diagnosis of Pediatric Hand and Wrist Fractures

Your child’s hand and wrist will be examined for deformity and evaluated for open injuries that could lead to infection. Range of motion should be tested as gently as possible. X rays of the front and sides of the hand and wrist are ordered to isolate the fracture.  

Management of Pediatric Hand and Wrist Fractures

Accurate diagnosis helps to determine the best plan of treatment for your child. The treatment options for pediatric hand and wrist fractures include:

  • Closed reduction or surgical intervention using suitable sedation for comfort of the child.
  • In older adolescents, the injured hand can be reduced using finger traps or a sling that suspends the hand in order to reduce the fracture gradually
  • Immobilization of a child’s hand and wrist can be done with a splint or cast 
  • Antibiotics and pain relievers can also be given to control pain and address infections
  • Usually hand fractures heal within about 4 weeks.  If the hand and wrist fracture is complex, percutaneous wires may be required to hold the fractured ends together. Screws and plates, metal pins, external fixators, or a combination of techniques can be used to approximate the fractured ends of the bones
  • If more than 25 percent of the fracture is seen involving the joint, open reduction and internal fixation is usually necessary

Follow Up Care of Pediatric Hand and Wrist Surgery

Children with complex fractures who had surgery should wear a cast or external fixator for 6 weeks. When the cast or fixator is removed, X-rays are repeated to ensure that your child’s wrist is healing properly

Once the fracture is stable, your child is encouraged to begin exercises to limit stiffness and regain range of movement. Depending on the complexity of your child’s fracture, physical therapy may also be recommended. Your children’s doctor will plan a specific protocol of management, depending on the type and site of the fracture, to help with their return to daily activities.