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Streamlining the Management of Children with Simple Hand Injuries
Lauren Wong1, Zina Sabir2, Patrick Sachsalber2
1Division of Plastic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Insights
A streamlined care pathway for simple pediatric hand injuries effectively minimizes healthcare utilization. Most children heal well with splinting or buddy taping, avoiding unnecessary follow-up visits and reducing burdens on families and healthcare systems.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Healthcare Management
Background:
- Hand injuries are frequent in children, with most simple fractures healing well via immobilization.
- An institutional audit highlighted practice variations and overtreatment with unnecessary follow-up visits for pediatric hand injuries.
- This study aimed to reduce healthcare utilization for simple pediatric hand injuries.
Purpose of the Study:
- To implement and assess a streamlined care pathway for managing simple pediatric hand injuries.
- To minimize healthcare resource utilization associated with these injuries.
- To evaluate the effectiveness of a non-routine follow-up approach.
Main Methods:
- A prospective study at a single institution evaluated a streamlined care pathway for simple hand injuries.
- Included injuries: volar plate, phalangeal Salter-Harris type 2, metacarpal neck, unicortical/buckle fractures, PIP dislocations, thumb ligament injuries.
- Treatment involved splinting or buddy taping with standardized instructions; no routine follow-up was scheduled. Patients were telephoned at 6 weeks.
Main Results:
- 101 children with simple hand injuries were enrolled; 61 completed a 6-week telephone survey.
- Approximately 90% reported no healing problems, and 85% resumed all activities.
- Only 10 participants requested follow-up, with 6 needing only reassurance, indicating high success with the pathway.
Conclusions:
- Simple pediatric hand injuries generally heal effectively with conservative management like splinting or buddy taping.
- The streamlined care pathway successfully reduces unnecessary follow-up visits for simple pediatric hand trauma.
- This approach alleviates the burden on both families and the healthcare system by optimizing resource allocation.
Abstract:
Background: Hand injuries are common in children. Most simple pediatric hand fractures do not require surgery and can be treated with protective immobilization, yielding good outcomes. A recent institutional audit revealed significant practice variation in managing these children with many being overtreated with unnecessary follow-up visits. The objective of this study was to implement and assess a streamlined care pathway to manage "simple" pediatric hand injuries and minimize healthcare utilization. Methods: A single institution prospective study of the streamlined care pathway was conducted. Simple hand injuries included volar plate injuries, phalangeal Salter-Harris type 2 fractures, metacarpal neck fractures, unicortical and buckle fractures, proximal interphalangeal dislocations, and thumb ligamentous injuries. Patients were treated with either thermoplastic splinting or buddy taping. Standardized verbal and written instruction were provided. No routine follow-up was arranged. Participants were contacted by telephone 6 weeks post-injury to identify any concerns or need for follow-up. Results: A total of 101 children with simple hand injuries were included. Sixty-one participants completed the telephone survey. About 90% had no problems during healing and 85% resumed all activities. Ten participants requested follow-up; however, 4 cancelled and the remaining 6 required reassurance with no additional treatment. Conclusions: Most simple pediatric hand injuries heal well with buddy taping or splint immobilization. The described streamlined hand pathway can avoid unnecessary follow-ups for simple pediatric hand trauma, reducing the burden on both families and the healthcare system.
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