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[First choice treatment of the pediatric wrist ganglia]
1Dipertimento di Chirurgia, S.S.v.D. delle Malformazioni Congenite, Ospedale Infantile Regina Margherita, Piazza polonia 94, 10126 Turin, Italy.
Insights
For pediatric wrist swelling, clinical observation and splinting are recommended first-line treatments for ganglia. Surgery is reserved for persistent cases, while aspiration is discouraged due to high recurrence rates.
Area of Science:
- Orthopedic Surgery
- Pediatric Hand Surgery
- Musculoskeletal Disorders
Context:
- Wrist ganglia are the most common cause of wrist swelling in children.
- Conservative management is often preferred for pediatric wrist ganglia.
Purpose:
- To analyze the characteristics of hand and wrist ganglia in pediatric patients.
- To evaluate the efficacy of conservative treatments like observation and splinting versus aspiration or surgery.
Summary:
- A 4-year study of 15 pediatric patients with wrist ganglia found that two-thirds experienced spontaneous re-absorption with observation and splinting.
- Surgical intervention was indicated for the remaining third due to persistent symptoms or pain.
- Aspiration was avoided due to high recurrence rates reported in literature.
Impact:
- Establishes clinical observation and nocturnal splinting as the primary treatment for pediatric wrist ganglia.
- Discourages aspiration, highlighting its ineffectiveness and high recurrence.
- Guides orthopedic surgeons in managing pediatric wrist ganglia, prioritizing conservative approaches.
Aim:
The authors analyze the anatomical, etiopathogenetic and clinical characteristics of ganglia of the hand and especially the radio-carpus, which represent the most frequent cause of wrist swelling in pediatric age. They underline the importance of an adequate period of clinical observation and splint treatment, as the first methodical choice, rather than aspiration or surgical immediate resection.
Methods:
The experience of the authors is based on splinting and/or surgical treatment on a series of 15 patients with wrist ganglion, with a follow-up of 4 years. The period of clinical observation had never been less than 6 months and the static splint had been recommended during nocturnal hours only, on a 3-4 month basis at least.
Results:
Two thirds of the cases showed spontaneous re-absorption of the ganglion, while in the remaining third part a surgical indication of removal had been suggested, due to absence of spontaneous remission and the presence of trouble or pain in movements. The authors never practice the aspiration of the content of the ganglion, since recent literature advises against it due to the high percentage of recurrence observed.
Conclusions:
The clinical observation and the dedicated nocturnal splinting of the wrist ganglia in pediatric age represent the first treatment advocated. Surgery is suggested in cases unsolved with a conservative therapy. Aspiration is strongly discouraged.
