Hand fractures and dislocations in the developing skeleton
Sheila G Lindley1, Gabriel Rulewicz
1Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA. slindley@orthopedics.umsmed.edu
Insights
Managing pediatric fractures needs understanding the developing skeleton and injury specifics. While bone remodeling is possible, it has limits, and stiffness, especially in finger joints, is a common concern.
Area of Science:
- Pediatric Orthopedics
- Skeletal Development
- Pediatric Trauma
Background:
- Effective management of pediatric fractures hinges on understanding the unique characteristics of the developing skeleton.
- Recognizing the injury pattern, mechanism, and anatomical location is crucial for predicting fracture outcomes.
Purpose of the Study:
- To outline the essential components for successful pediatric fracture management.
- To emphasize the predictable nature of bone remodeling and its limitations.
- To highlight the frequency of persistent stiffness in specific pediatric fractures.
Main Methods:
- Review of established principles in pediatric fracture care.
- Analysis of fracture healing and remodeling potential in children.
- Clinical observation and radiological assessment of fracture outcomes.
Main Results:
- Bone remodeling potential is significant but limited, particularly outside the direction of joint motion.
- Growth arrest following pediatric fractures is rare.
- Persistent stiffness, especially at the proximal interphalangeal (PIP) joints, is more common than often perceived, particularly with phalangeal shaft, condylar, and neck fractures.
Conclusions:
- Successful pediatric fracture management requires comprehensive knowledge of skeletal development, meticulous clinical and radiological follow-up, and timely intervention for unacceptable deformity.
- Overreliance on remodeling potential should be avoided, especially concerning joint motion.
- Clinicians must be vigilant for the development of stiffness in pediatric fractures, particularly involving the phalanges.
Abstract:
Management of children's fractures requires a thorough knowledge of the developing skeleton, with recognition of the injury present and its potential course based on mechanism and anatomy, a dedication to complete and repeated clinical and radiologic examinations, and a willingness to intercede if unacceptable angulation or any rotation occurs in the course of treatment. The ability to remodel follows a well-defined course and may be anticipated within certain margins, but expectations of this ability should not be overemphasized or even contemplated outside the direction of joint motion. Growth arrest following injury, although a real concern, remains rare. Persistent stiffness, particularly at the PIP joint, occurs much more frequently than is perceived, particularly for phalangeal shaft, condylar, and neck fractures.
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