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Hand, Finger and Wrist Injuries in Pediatric Athletes

Hand, wrist and finger injuries are some of the most common injuries in children who play sports. They fall into two basic categories: acute, resulting from an injury, or chronic, due to overuse or repetitive stress on the upper limb. Acute injuries include fractures, joint sprains and dislocations.

In this blog post, we will focus on fractures and answer a few of the most common questions we get from parents at The Pediatric Orthopedic Center when their child or teenager sustains a hand, finger or wrist fracture.

What kinds of injuries do you see in your practice and why?

Kids are developing athletic skills and competing in sports at a higher level and at younger ages than ever before. They’re also increasingly playing their sports year- round.  As a result, we are seeing two trends in the types of injuries in pediatric athletes. Overall, children are experiencing many more hand, finger and wrist injuries. In addition, we are seeing adult-type injuries in our young athletes, such as scaphoid fractures. 

Some of the most common hand, finger and wrist injuries we see in children are fractures that involve the growth plate. Children’s bones have growth plates (bands of cartilage near the ends of the bone). The growth plates are weaker than the surrounding bone and ligaments and are therefore commonly injured or fractured, resulting in injuries that are unique to children. Growth plate injuries occur particularly to the wrist (the end of the radius and ulna) and can impact the overall growth of the forearm, as well as wrist alignment and motion.

How do you know if a hand injury is serious?

Warning signs for serious issues that may be associated with certain fractures are a deformity of the finger or wrist, an open wound, inability to move the affected finger, hand or wrist, numbness or tingling in the fingers, or if your child experiences recurrent pain with activities. If your child is experiencing any of these symptoms, it is critical that they are properly evaluated to prevent missing an injury that may result in lifelong deformity or disability. 

On the field or court, it’s important to have good communication with coaches and trainers when there is an injury to determine if prompt medical attention is needed. 

If your child sustains an injury, the severity can range widely. If you as the parent have any concerns, we always recommend a medical evaluation. By accurately diagnosing the problem we can treat it appropriately to minimize the risk of long-term problems. Initial evaluation by the pediatric orthopedist includes physical examination and usually X-rays.

What kind of treatments are there for hand or wrist injuries and fractures?

Depending on the type or extent of the injury, the following common treatments are used:

Closed reduction: If a child has a significantly displaced fracture, or has suffered from a finger joint dislocation, the injury needs to be “set” or reduced back into place. This involves manipulating the bone or joint back into the normal position. This can usually be done without the need for surgery. This is followed by a short period of immobilization with either taping, splinting, or casting the injured area. We try to limit the period of immobilization so that the child regains their motion and strength and returns to sports as soon as possible.

Hand or wrist surgery: Sometimes surgery is needed to realign the fracture and prevent a permanent deformity, or to reduce a joint dislocation that cannot be reduced with a closed reduction. Surgery is also sometimes required to repair ligaments that have been torn.  Since surgery aligns the fracture, the injury may heal more quickly than without surgery and lessen the risk of re-injury when the child returns to sports. Some surgeries may require pins or rods to hold the fracture in place.

With both courses of treatment our goals are the same: to regain full range of motion, full strength, and full function as early as possible.

Why is treatment for children’s hand injuries different than in adults?

The main difference between treating injuries in children vs. adults is the type of injuries themselves. As noted above, the growth plates in a child’s hand, wrist, and forearm can get injured. We don’t see those injuries in adults because their growth plates are closed. For example, a common injury is a growth plate fracture to the distal radius, or the phalanx (finger). In general, children heal more quickly than adults, and in many cases physical therapy is not needed for full recovery. So, the time necessary for healing, recovery, and rehabilitation in children is different than for adults.

Scaphoid fractures used to be rare in kids, but today, we are seeing more younger patients sustain these injuries. Scaphoid fractures are often due to a fall onto an outstretched hand. These injuries are important to diagnose and treat early to avoid persistent wrist pain later. Sometimes, these fractures are missed on an X-ray, so having a pediatric orthopedist review the image and examine the child is critical to timely intervention and good outcomes.

What about hand injury prevention?  

As parents, we all know falls will unfortunately happen and kids will get injured, as they always have. Some sports for protective gear such as wrist guards, taping fingers, and other standard equipment to curtail potential hand injury. Proper use of sports equipment is also important to minimize the risk of injury.

When can my child return to the field or court?

We know getting back to playing sports is a priority for our young athletes and their parents. After all, I am a parent and participated in competitive sports, too. Like you, our goal in our practice is to make sure your child makes a full recovery from their injury, with an eye toward a return to sports as soon and as safely as possible. We make the best recommendation for returning to activities with this in mind.

The timeframe for returning to sports after a hand, wrist or finger injury is important. Returning to sports is a delicate balance between compliance, type of sport, type of injury, and age of the athlete, and involves an individualized treatment plan which requires the cooperation of parents, child and coaches alike to follow for maximum success. Returning too soon could result in re-injury, pain, and/or affect sports performance. In general, we aim to have children return in a “controlled” fashion to sports, meaning some limitations initially, and possibly with a protective device (like a brace or splint) if they are participating in a contact or collision sport.

Treating hand fractures and injuries at TPOC

If your child has suffered an acute injury due to an accident, or you suspect a chronic injury from repetitive stress on the joints and muscles, it’s time for an orthopedic exam and diagnosis. Early intervention and proper treatment will help keep young athletes competing happily and safely for many years to come. Come and see us to ensure the best care for your child.

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