Paediatric Hand Fractures - A Review

Abstract

Paediatric hand fractures account for approximately 25% of hand-related emergency department visits, making them the second most common childhood fractures after distal forearm fractures. These injuries are more prevalent in boys and peak ages between 9 and 14 years. Hand fractures in children are primarily caused by crushing injuries and, increasingly in older children, by sports-related activities. The little finger (52%) and thumb (23%) are the most frequently fractured digits, with phalangeal fractures, especially of the proximal phalanx, being common. Metacarpal fractures are more prevalent in adolescents (13-16 years) compared to younger children. Accurate diagnosis in the paediatric population is complicated by difficult clinical examinations and the presence of growth plates, leading to an 8% misdiagnosis rate, mainly due to misinterpretation of the ossification centres and physes. High-quality radiographic evaluation combined with a thorough clinical assessment is critical for correct diagnosis and appropriate management. The robust periosteum and high remodelling potential of paediatric bones allow most hand fractures to be managed non-operatively with splinting or casting. However, fractures with significant angulation, rotation, intra-articular involvement or open wounds may require surgical intervention, such as closed or open reduction and internal fixation with Kirschner wires. Most paediatric hand fractures heal well with excellent functional outcomes due to the high remodelling capacity of paediatric bones. Early mobilisation and appropriate immobilisation are key to preventing stiffness. Despite the generally favourable prognosis, certain fractures remain challenging to diagnose and treat, highlighting the need for specialised care. The aim of this review article is to discuss the epidemiology, fracture patterns, diagnostic challenges and management strategies essential for optimising functional outcomes and minimising long-term complications in treating paediatric hand fractures. Level of Evidence: Level V (Therapeutic).

Keywords: Conservative treatment; Diagnosis; Paediatric hand fractures; Remodelling potential; Surgical intervention.