A prospective study of pediatric hand fractures and review of the literature.
OBJECTIVE
Hand fractures represent a leading cause of morbidity in children. However, little information exists correlating the mechanisms and environment of injury with outcomes and treatments. We examine the demographics, etiology, anatomic location, mechanism, and management of pediatric hand fractures in our center's hand unit.


METHODS
We conducted a prospective observational study on all children with acute hand fractures evaluated in the Plastic Surgery Emergency Clinic during a 3-month period in 2010. Data pertaining to demographics, referral patterns, injury pattern, clinical outcomes, and other factors related to hand fractures were then analyzed and interpreted.


RESULTS
Most children were referred by our institution's emergency department. More than 60% were boys, and nearly half were between 10 and 15 years old. The right and left hands were injured at equal rates. Most of the injuries (90%) occurred in the afternoon or evening. More than 85% occurred in urban, rather than rural, environments. Crush injuries were the leading cause in toddlers, whereas sports-related injuries became the major cause of injury in older groups. Proximal phalanges were the most common bone injured, and the fifth digit was the most commonly injured digit. More than 80% of the fractures were managed nonsurgically.


CONCLUSIONS
The pattern of pediatric hand fracture in different age groups is highlighted in this article. The observations from this study will hopefully encourage further review with a larger cohort and a focus on preventative measures for pediatric hand fractures.
From the *Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario; †Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario; ‡Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario; §College of Medicine, King Saud University, Riyadh, Saudi Arabia; ∥Department of Pediatrics, University of Manitoba, Winnipeg, MB; ¶Department of Occupational Science and Occupational Therapy and Institutes of #Biomaterials and Biomedical Engineering and **Medical Sciences, University of Toronto, Toronto, Ontario; and ††Program in Physiology and Experimental Medicine, The Hospital for Sick Children Research Institute, Toronto, Ontario.
Edward H
EH
Liu
Saad
S
Alqahtani
Rasha N
RN
Alsaaran
Emily S
ES
Ho
Ronald M
RM
Zuker
Gregory H
GH
Borschel
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006230:Hand Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome