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Epiphyseal injuries in the small joints of the hand
1Department of Orthopaedic Surgery, Lewis-Gale Clinic, Inc., Salem, Virginia.
Insights
Treating pediatric hand epiphyseal injuries requires patience and modified immobilization. Understanding injury mechanisms and growth potential is crucial for effective management and parental counseling.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Hand Surgery
Background:
- Epiphyseal injuries in children require specialized management.
- Hand epiphyseal injuries, particularly in proximal phalanges and thumb metacarpal, are common.
- Growth plate injuries can lead to long-term functional deficits if not managed properly.
Purpose of the Study:
- To outline the principles for managing epiphyseal injuries of the hand in pediatric patients.
- To emphasize the importance of understanding injury mechanisms and growth potential.
- To guide physicians in counseling parents regarding potential outcomes.
Main Methods:
- Review of established principles for treating pediatric epiphyseal injuries.
- Application of these principles to hand-specific injuries.
- Consideration of patient age and activity level in immobilization techniques.
Main Results:
- Salter Type I and II fractures show good remodeling potential.
- Intra-articular Salter Type III and IV fractures often necessitate surgical intervention.
- These intra-articular fractures are associated with higher risks of growth disturbance and post-traumatic arthritis.
Conclusions:
- Effective management hinges on patience, modified immobilization, and understanding injury biomechanics.
- Physician-parent trust is vital for treatment compliance and managing expectations.
- Adherence to these principles leads to favorable long-term outcomes for pediatric patients with hand epiphyseal injuries.
Abstract:
The principles followed in treatment of epiphyseal injuries of the hand are essentially the same as those used in treating epiphyseal injuries elsewhere in the child. Special patience is required in treating the patients, and methods of immobilization must be modified appropriately for the active child. A knowledge of the mechanism of injury and potential effects on the growth potential of the digit are important in determining treatment and counseling parents on possible growth disturbance and later deformity. The epiphyses of the proximal phalanges of the fingers and the thumb metacarpal are the most frequently injured. Salter Type I and II fractures frequently demonstrate remarkable remodeling potential, whereas intra-articular Salter III and IV fractures often require surgical repair and may be more frequently associated with later problems of growth and post-traumatic arthritis. The physician should establish a trusting relationship with the child and his or her parents in order to provide comforting reassurance, facilitate treatment and compliance, and promote an understanding of the possible outcomes associated with injuries of the vulnerable growth plate. When these principles are followed appropriately, the long-term follow-up of these children provides for a very satisfying and rewarding experience for the physician and family.
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