gms | German Medical Science

Objectives/Interrogation: Fractures in the bones of the hand are a common injury both in children and adolescents. Hand fractures which are unstable, oblique, or have a rotational deformity, or are pathologic or open are an indication for surgery.

Methods: The authors evaluated in a retrospective study the therapeutic options and results of operatively treated paediatric hand fractures of patients treated between 1st January 2016 and 1st January 2018. Gender distribution, age specifics, fracture mechanism, operative treatment method, and final results after metal removal were inspected. In the above period alltogether 42 patients were treated because of the fracture of one or more long finger phalanx (33/42) or fracture of the metacarpus (9).

Results and Conclusions: In the case of the phalangeal injuries (33/42), 21 patients were male and 12 were female. All patients with the metacarpal fractures were male. Most injuries occured both in the phalanx (25/33) as well as in the metacarpus group (9/9) above the age of 10. The most common mechanism of injury was direct trauma caused by a ball. Among the patients with phalangeal fractures an identical function to the contralateral side was found in 28/33 patients, whereas in 5/33 patiens good functional results were found. In the metacarpal injury group identical functional results to the contralateral side were found in 7/9 patients, good function was seen in 1/9 and bad function was found in 1/9. In most phalanx injured patients the external retention (aluminum splint, plaster, orthesis) was removed at the 3rd week, whereas the K wires were removed on the 5th-6th week. In the case of patients treated with elastic nails because of a metacarpal fracture (7/9), the involved finger was taped to the neighbouring intact finger. Following a week in a cast, functional therapy was started with a physical therapist. The elastic nail was removed after complete remodelling of the fracture. In the cases of angle stable plate osteosynthesis (2/9) we used external fixation till the healing of the soft tissue. In these cases there was no metal removal.

Conclusion: In the case of hand injuries requiring operative treatment, one should always strive for an accurate reduction. In the case of minimally invasive methods, the most stable and simple fixation should be used. By choosing the above operation types in most cases outstanding results can be achieved in childhood and adolescence.