Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 25;8(3):e2703.
doi: 10.1097/GOX.0000000000002703. eCollection 2020 Mar.

Surgical and Nonsurgical Pediatric Hand Fractures: A Cohort Study

Rebecca L Hartley  1 , Josh Lam  2 , Ceilidh Kinlin  3 , Karen Hulin  4 , Claire Temple-Oberle  1 , A Robertson Harrop  1   5 , Frankie O G Fraulin  1   5
Affiliations

Surgical and Nonsurgical Pediatric Hand Fractures: A Cohort Study

Rebecca L Hartley et al. Plast Reconstr Surg Glob Open. .

Abstract

Pediatric hand fractures are common and approximately 10% require surgery.

Methods: This retrospective cohort study reports on hand fractures in a large pediatric population and identifies the characteristics and patterns of fractures that required surgical correction. A χ2 analysis was done to evaluate the association between individual fracture variables and surgery. The STROBE checklist was applied.

Results: One thousand one-hundred seventy-three hand fractures were reviewed. Peak age was 16 years for boys and 14 years for girls. Most fractures were closed (96.0%) and nonrotated (91.3%), and had no concomitant soft tissue injury (72.7%). More than half (56.3%) were nonepiphyseal plate fractures; yet as a single diagnosis, Salter-Harris II fractures were most common (30.2%). The following variables were significantly associated with surgery: open fractures, rotational deformity, distal phalangeal fracture location, multiple fractures, oblique pattern, comminution, displacement >2 mm, intra-articular involvement, and angulation >15°. Most fractures required only immobilization and early range of motion (64.3%). Closed reduction was required in 22.7%. Minor surgery by the primary provider was performed in 3.2% of fractures. Surgery by a hand surgeon was performed in 9.8%. The most common patterns requiring surgery were proximal or middle phalanx head or neck fractures (38.2%) and metacarpal midshaft fractures (20.9%). The most common operation was open reduction internal fixation (52.2%).

Conclusions: Pediatric hand fractures are common, but 90.2% do not require surgery and, as such, primary providers play a key role in management. Certain fracture variables and patterns are more likely to lead to surgery.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Patient flow diagram and hand fracture management.
Fig. 2.
Fig. 2.
Example radiographs of common surgical fractures. A, Unicondylar proximal phalanx fracture. B, Proximal phalangeal neck fracture. C, Multiple oblique midshaft metacarpal fractures. D, Transverse midshaft metacarpal fracture.
See this image and copyright information in PMC

References

    1. Cooper C, Dennison EM, Leufkens HG, et al. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res. 2004;19:1976–1981. - PubMed
    1. Hastings H, II, Simmons BP. Hand fractures in children. Clin Orthop Relat Res. 1984;188:120–130. - PubMed
    1. Landin LA. Fracture patterns in children. Acta Orthopaedica Scandinavica. 198354suppl 2023–109. - PubMed
    1. Liu EH, Alqahtani S, Alsaaran RN, et al. A prospective study of pediatric hand fractures and review of the literature. Pediatr Emerg Care. 2014;30:299–304. - PubMed
    1. Mahabir RC, Kazemi AR, Cannon WG, et al. Pediatric hand fractures: a review. Pediatr Emerg Care. 2001;17:153–156. - PubMed