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Published on: February 25, 2022
Traumatic arthritis of the hand and wrist in children
1Hand Treatment Center, Children's Healthcare of Atlanta, Scottish Rite Hospital, Atlanta, Georgia, USA.
Insights
Nonoperative treatments are preferred for pediatric hand and wrist posttraumatic arthritis. Surgery, when necessary, prioritizes motion preservation, with arthrodesis suitable for specific joints.
Area of Science:
- Orthopedic Surgery
- Pediatric Rheumatology
- Hand and Wrist Trauma
Background:
- Posttraumatic arthritis in pediatric hand and wrist joints presents unique challenges.
- Treatment decisions require careful consideration of joint stability and congruence.
Purpose of the Study:
- To outline principles for managing painful, posttraumatic arthritis in pediatric hand and wrist.
- To guide treatment strategies, emphasizing nonoperative measures and appropriate surgical interventions.
Main Methods:
- Review of current treatment principles and literature.
- Emphasis on conservative management before surgical consideration.
- Discussion of surgical options, including motion-preserving procedures and arthrodesis.
Main Results:
- Nonoperative measures are the initial preference unless joints are unstable or incongruent.
- Cautious observation is advised in young children due to remodeling potential.
- Motion-preserving surgeries are favored, with arthrodesis being a viable option for specific joints (thumb IP, finger DIP).
Conclusions:
- Treatment of pediatric posttraumatic hand and wrist arthritis should be guided by principles, not rigid rules.
- A phased approach, starting with nonoperative management and progressing to tailored surgical interventions, is recommended.
- Experienced surgical management is crucial for complex cases and novel reconstructive techniques.
Abstract:
Principles, and not established rules, form the basis for treating children with painful, posttraumatic arthritis involving the hand and wrist. The authors' preference is to exhaust nonoperative measures unless the involved joints are unstable or grossly incongruent. The authors would also recommend a greater degree of cautious observation in young children because of reports of successful outcomes associated with remodeling. Once surgery is necessary, the authors prefer motion-preserving procedures, bearing in mind that arthrodesis is well tolerated in the thumb interphalangeal joint and the finger DIP joints. Some authors have presented novel treatments, including complex microvascular reconstructions, but these authors recommend these procedures only in special circumstances, and only by physicians who are experienced with the techniques.
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