[Particularities of hand trauma in children]

The hand is a commonly inljured location of a child. Fractures are the most frequent lesions with two specific locations. In the young child, the fracture is usually a crush injury, such as occurs when a hand gets caught in a door, with lesion of the distal phalanx. Soft tissue associated injuries are the main problem in this location. In the older child, the fracture is usually secondary to recreational sports, with lesion on the proximal phalanx of the second and fifth digits. Dislocations or sprains are less common. A metacarpophalangeal joint dislocation is more likely to be irreducible secondary to volar plate entrapment. Open reduction is often necessary Most hand injuries in children are treated nonoperatively with a favorable outcome. The treating physician should however identify those cinical situations that require surgery, as complications are most commonly due to a failure to identify and treat an injury requiring an operation acutely. These injuries include intra-articular fractures, displaced phalangeal neck fractures and malrotated fractures. Malrotation or intra articular malunion have no remodeling capacity.