Surgical and Nonsurgical Pediatric Hand Fractures: A Cohort Study
Rebecca L Hartley1, Josh Lam2, Ceilidh Kinlin3
1Section of Plastic Surgery, Department of Surgery, University of Calgary.
Insights
Most pediatric hand fractures (90.2%) do not require surgery. Key factors predicting surgical need in pediatric hand fractures include open fractures, displacement, and specific fracture patterns.
Area of Science:
- Orthopedics
- Pediatric Traumatology
- Hand Surgery
Background:
- Pediatric hand fractures are a frequent occurrence in children.
- While most fractures heal with conservative management, a subset necessitates surgical intervention.
Purpose of the Study:
- To identify characteristics and patterns of pediatric hand fractures that require surgical correction.
- To analyze factors associated with surgical intervention in pediatric hand injuries.
Main Methods:
- Retrospective cohort study of 1,173 pediatric hand fractures.
- Statistical analysis (chi-squared) to determine associations between fracture variables and surgery.
- Adherence to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
Main Results:
- Peak incidence in 16-year-old boys and 14-year-old girls; 96% were closed fractures.
- Fracture variables associated with surgery: open fractures, rotational deformity, distal phalangeal location, comminution, displacement, intra-articular involvement, and angulation.
- 90.2% of fractures did not require surgery; common surgical patterns included phalanx head/neck and metacarpal midshaft fractures.
Conclusions:
- The vast majority of pediatric hand fractures are managed non-surgically, highlighting the crucial role of primary care providers.
- Specific fracture characteristics and patterns are predictive of the need for surgical management in pediatric hand injuries.
Abstract:
Pediatric hand fractures are common and approximately 10% require surgery.
Methods:
This retrospective cohort study reports on hand fractures in a large pediatric population and identifies the characteristics and patterns of fractures that required surgical correction. A χ2 analysis was done to evaluate the association between individual fracture variables and surgery. The STROBE checklist was applied.
Results:
One thousand one-hundred seventy-three hand fractures were reviewed. Peak age was 16 years for boys and 14 years for girls. Most fractures were closed (96.0%) and nonrotated (91.3%), and had no concomitant soft tissue injury (72.7%). More than half (56.3%) were nonepiphyseal plate fractures; yet as a single diagnosis, Salter-Harris II fractures were most common (30.2%). The following variables were significantly associated with surgery: open fractures, rotational deformity, distal phalangeal fracture location, multiple fractures, oblique pattern, comminution, displacement >2 mm, intra-articular involvement, and angulation >15°. Most fractures required only immobilization and early range of motion (64.3%). Closed reduction was required in 22.7%. Minor surgery by the primary provider was performed in 3.2% of fractures. Surgery by a hand surgeon was performed in 9.8%. The most common patterns requiring surgery were proximal or middle phalanx head or neck fractures (38.2%) and metacarpal midshaft fractures (20.9%). The most common operation was open reduction internal fixation (52.2%).
Conclusions:
Pediatric hand fractures are common, but 90.2% do not require surgery and, as such, primary providers play a key role in management. Certain fracture variables and patterns are more likely to lead to surgery.
