Hand Injuries in Children

  • David McCombeEmail author


Hand trauma in children is common, but often inadequately assessed and treated. The types of injury vary with age depending on the pattern of hand use. Assessment of the injury, particularly in the younger child, can be difficult, given the inability or reluctance of the child to co-operate, both in providing a history and allowing an examination of the injured hand. The established principles of treatment for hand trauma, detailed elsewhere in this text, apply equally to children, but the healing and growth potential of the child has specific implications for management. The management plan also has to take into account the varying capacity of the child for co-operation with active rehabilitation programmes.


Hand injury Children Fingertip Nail bed injury Hand fracture Wrist fracture Joint injury Flexor tendon Extensor tendon Nerve injury Vascular injury Replantation Growth plate fracture 


  1. 1.
    Ljungberg E, Dahlin LB, Granath F, Blomqvist P. Hospitalized Swedish children with hand and forearm injuries: a retrospective review. Acta Paediatr. 2006;95(1):62–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Vadivelu R, Dias JJ, Burke FD, Stanton J. Hand injuries in children: a prospective study. J Pediatr Orthop. 2006;26(1):29–35.PubMedCrossRefGoogle Scholar
  3. 3.
    De Jonge JJ, Kingma J, van der Lei B, Klasen HJ. Phalangeal fractures of the hand. An analysis of gender and age-related incidence and aetiology. J Hand Surg Br. 1994;19(2):168–70.PubMedCrossRefGoogle Scholar
  4. 4.
    Valencia J, Leyva F, Gomez-Bajo GJ. Pediatric hand trauma. Clin Orthop Relat Res. 2005;432:77–86.PubMedCrossRefGoogle Scholar
  5. 5.
    Evans DM, Bernardis C. A new classification for fingertip injuries. J Hand Surg Br. 2000;25(1):58–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg Am. 1999;24(6):1166–70.PubMedCrossRefGoogle Scholar
  7. 7.
    Strauss EJ, Weil WM, Jordan C, Paksima N. A prospective, randomized, controlled trial of 2-octylcyanoacrylate versus suture repair for nail bed injuries. J Hand Surg Am. 2008;33(2):250–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson M, Shuster S. Continuous formation of nail along the bed. Br J Dermatol. 1993;128(3):277–80.PubMedCrossRefGoogle Scholar
  9. 9.
    Ishikawa K, Ogawa Y, Soeda H. A new classification of the amputation level for the distal part of the finger. J Jpn SRM. 1990;3:54–62.Google Scholar
  10. 10.
    Tamai S. Twenty years’ experience of limb replantation–review of 293 upper extremity replants. J Hand Surg Am. 1982;7(6):549–56.PubMedCrossRefGoogle Scholar
  11. 11.
    Hattori Y, Doi K, Ikeda K, Abe Y, Dhawan V. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg. 2003;111(3):1151–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Hsu CC, Lin YT, Moran SL, Lin CH, Wei FC. Arterial and venous revascularization with bifurcation of a single central artery: a reliable strategy for Tamai Zone I replantation. Plast Reconstr Surg. 2010;126(6):2043–51.PubMedCrossRefGoogle Scholar
  13. 13.
    Han SK, Chung HS, Kim WK. The timing of neovascularization in fingertip replantation by external bleeding. Plast Reconstr Surg. 2002;110(4):1042–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Dautel G, Barbary S. Mini replants: fingertip replant distal to the IP or DIP joint. J Plast Reconstr Aesthet Surg. 2007;60(7):811–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Eo S, Hur G, Cho S, Azari KK. Successful composite graft for fingertip amputations using ice-cooling and lipo-prostaglandin E1. J Plast Reconstr Aesthet Surg. 2009;62(6):764–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Hong JP, Lee SJ, Lee HB, Chung YK. Reconstruction of fingertip and stump using a composite graft from the hypothenar region. Ann Plast Surg. 2003;51(1):57–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Salter RB, Harris WR. Injuries involving the epiphyseal plate: instructional course lectures of the AAOS. J Bone Joint Surg Am. 1963;45:587–622.Google Scholar
  18. 18.
    Papadonikolakis A, Li Z, Smith BP, Koman LA. Fractures of the phalanges and interphalangeal joints in children. Hand Clin. 2006;22(1):11–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Seymour N. Juxta-epiphysial fracture of the terminal phalanx of the finger. J Bone Joint Surg. 1966;48(2):347–9.Google Scholar
  20. 20.
    Al-Qattan MM. Extra-articular transverse fractures of the base of the distal phalanx (Seymour’s fracture) in children and adults. J Hand Surg Br. 2001;26(3):201–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Waters PM, Taylor BA, Kuo AY. Percutaneous reduction of incipient malunion of phalangeal neck fractures in children. J Hand Surg Am. 2004;29(4):707–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Al-Qattan MM. Phalangeal neck fractures in children: classification and outcome in 66 cases. J Hand Surg Br. 2001;26(2):112–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Simmons BP, Peters TT. Subcondylar fossa reconstruction for malunion of fractures of the proximal phalanx in children. J Hand Surg Am. 1987;12(6):1079–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Hastings 2nd H, Simmons BP. Hand fractures in children. A statistical analysis. Clin Orthop Relat Res. 1984;188:120–30.PubMedGoogle Scholar
  25. 25.
    Cornwall R. Finger metacarpal fractures and dislocations in children. Hand Clin. 2006;22(1):1–10.PubMedCrossRefGoogle Scholar
  26. 26.
    Waters PM. Operative carpal and hand injuries in children. J Bone Joint Surg Am. 2007;89(9):2064–74.PubMedGoogle Scholar
  27. 27.
    Elhassan BT, Shin AY. Scaphoid fracture in children. Hand Clin. 2006;22(1):31–41.PubMedCrossRefGoogle Scholar
  28. 28.
    Sferopoulos NK. Bone bruising of the distal forearm and wrist in children. Injury. 2009;40(6):631–7.PubMedCrossRefGoogle Scholar
  29. 29.
    La Hei N, McFadyen I, Brock M, Field J. Scaphoid bone bruising–probably not the precursor of asymptomatic non-union of the scaphoid. J Hand Surg Eur Vol. 2007;32(3):337–40.PubMedGoogle Scholar
  30. 30.
    Joseph B. Fractures of the forearm bones. In: Gupta A, Kay S, Scheker L, editors. The growing hand. London: Mosby; 2000. p. 567–81.Google Scholar
  31. 31.
    Blount WP. Forearm fractures in children. Clin Orthop Relat Res. 1967;51:93–107.PubMedGoogle Scholar
  32. 32.
    Bae DS, Waters PM. Pediatric distal radius fractures and triangular fibrocartilage complex injuries. Hand Clin. 2006;22(1):43–53.PubMedCrossRefGoogle Scholar
  33. 33.
    Younger AS, Tredwell SJ, Mackenzie WG, Orr JD, King PM, Tennant W. Accurate prediction of outcome after pediatric forearm fracture. J Pediatr Orthop. 1994;14(2):200–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Chess DG, Hyndman JC, Leahey JL, Brown DC, Sinclair AM. Short arm plaster cast for distal pediatric forearm fractures. J Pediatr Orthop. 1994;14(2):211–3.PubMedCrossRefGoogle Scholar
  35. 35.
    Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop. 2005;25(4):490–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Waters PM, Kolettis GJ, Schwend R. Acute median neuropathy following physeal fractures of the distal radius. J Pediatr Orthop. 1994;14(2):173–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Waters PM, Bae DS, Montgomery KD. Surgical management of posttraumatic distal radial growth arrest in adolescents. J Pediatr Orthop. 2002;22(6):717–24.PubMedGoogle Scholar
  38. 38.
    Light TR, Ogden JA. Complex dislocation of the index metacarpophalangeal joint in children. J Pediatr Orthop. 1988;8(3):300–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Kaplan EB. Dorsal dislocation of the metacarpophalangeal joint of the index finger. J Bone Joint Surg Am. 1957;39-A(5):1081–6.PubMedGoogle Scholar
  40. 40.
    Bohart PG, Gelberman RH, Vandell RF, Salamon PB. Complex dislocations of the metacarpophalangeal joint. Clin Orthop Relat Res. 1982;164:208–10.PubMedGoogle Scholar
  41. 41.
    Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. J Bone Joint Surg Br. 1962;44-B(4):869–79.Google Scholar
  42. 42.
    Kozin SH. Fractures and dislocations along the pediatric thumb ray. Hand Clin. 2006;22(1):19–29.PubMedCrossRefGoogle Scholar
  43. 43.
    Graham TJ, Hastings 2nd H. Carpal injuries in children. In: Gupta A, Kay S, Scheker L, editors. The growing hand. London: Mosby; 2000. p. 583–90.Google Scholar
  44. 44.
    Terry CL, Waters PM. Triangular fibrocartilage injuries in pediatric and adolescent patients. J Hand Surg Am. 1998;23(4):626–34.PubMedCrossRefGoogle Scholar
  45. 45.
    Tang JB, Zhang Y, Cao Y, Xie RG. Core suture purchase affects strength of tendon repairs. J Hand Surg Am. 2005;30(6):1262–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Navali AM, Rouhani A. Zone 2 flexor tendon repair in young children: a comparative study of four-strand versus two-strand repair. J Hand Surg Eur Vol. 2008;33(4):424–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Lalonde DH. An evidence-based approach to flexor tendon laceration repair. Plast Reconstr Surg. 2011;127(2):885–90.PubMedCrossRefGoogle Scholar
  48. 48.
    Favetto JM, Rosenthal AI, Shatford RA, Kleinert HE. Tendon injuries in children. In: Gupta A, Kay S, Scheker L, editors. The growing hand. London: Mosby; 2000. p. 609–27.Google Scholar
  49. 49.
    Kato H, Minami A, Suenaga N, Iwasaki N, Kimura T. Long-term results after primary repairs of zone 2 flexor tendon lacerations in children younger than age 6 years. J Pediatr Orthop. 2002;22(6):732–5.PubMedGoogle Scholar
  50. 50.
    Fitoussi F, Lebellec Y, Frajman JM, Pennecot GF. Flexor tendon injuries in children: factors influencing prognosis. J Pediatr Orthop. 1999;19(6):818–21.PubMedGoogle Scholar
  51. 51.
    Thien TB, Becker JH, Theis JC. Rehabilitation after surgery for flexor tendon injuries in the hand. Cochrane Database Syst Rev. 2004;(4):CD003979.Google Scholar
  52. 52.
    O’Connell SJ, Moore MM, Strickland JW, Frazier GT, Dell PC. Results of zone I and zone II flexor tendon repairs in children. J Hand Surg Am. 1994;19(1):48–52.PubMedCrossRefGoogle Scholar
  53. 53.
    Havenhill TG, Birnie R. Pediatric flexor tendon injuries. Hand Clin. 2005;21(2):253–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Birnie RH, Idler RS. Flexor tenolysis in children. J Hand Surg Am. 1995;20(2):254–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Gilbert A, Masquelet A. Primary repair of flexor tendons in children. In: Tubiana R, editor. The hand. Philadelphia: Saunders; 1998. p. 359–63.Google Scholar
  56. 56.
    Cunningham MW, Yousif NJ, Matloub HS, Sanger JR, Gingrass RP, Valiulis JP. Retardation of finger growth after injury to the flexor tendons. J Hand Surg Am. 1985;10(1):115–7.PubMedCrossRefGoogle Scholar
  57. 57.
    Gaisford JC, Fleegler EJ. Alterations in finger growth following flexor tendon injuries. A clinical and laboratory study. Plast Reconstr Surg. 1973;51(2):164–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Amadio PC. Staged flexor tendon reconstruction in children. Ann Chir Main Memb Super. 1992;11(3):194–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Courvoisier A, Pradel P, Dautel G. Surgical outcome of one-stage and two-stage flexor tendon grafting in children. J Pediatr Orthop. 2009;29(7):792–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Fitoussi F, Badina A, Ilhareborde B, Morel E, Ear R, Pennecot GF. Extensor tendon injuries in children. J Pediatr Orthop. 2007;27(8):863–6.PubMedCrossRefGoogle Scholar
  61. 61.
    Lundborg G. A 25-year perspective of peripheral nerve surgery: evolving neuroscientific concepts and clinical significance. J Hand Surg Am. 2000;25(3):391–414.PubMedCrossRefGoogle Scholar
  62. 62.
    Navarro X, Vivo M, Valero-Cabre A. Neural plasticity after peripheral nerve injury and regeneration. Prog Neurobiol. 2007;82(4):163–201.PubMedCrossRefGoogle Scholar
  63. 63.
    Tajima T, Imai H. Results of median nerve repair in children. Microsurgery. 1989;10(2):145–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Onne L. Recovery of sensibility and sudomotor activity in the hand after nerve suture. Acta Chir Scand Suppl. 1962;(Suppl 300):1–69.Google Scholar
  65. 65.
    Lundborg G, Rosen B. Sensory relearning after nerve repair. Lancet. 2001;358(9284):809–10.PubMedCrossRefGoogle Scholar
  66. 66.
    Seddon HJ. A classification of nerve injuries. Br Med J. 1942;2(4260):237–9.PubMedCentralPubMedCrossRefGoogle Scholar
  67. 67.
    Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951;74(4):491–516.PubMedCrossRefGoogle Scholar
  68. 68.
    Tagliafico A, Altafini L, Garello I, Marchetti A, Gennaro S, Martinoli C. Traumatic neuropathies: spectrum of imaging findings and postoperative assessment. Semin Musculoskelet Radiol. 2010;14(5):512–22.PubMedCrossRefGoogle Scholar
  69. 69.
    Papazian O, Alfonso I, Yaylali I, Velez I, Jayakar P. Neurophysiological evaluation of children with traumatic radiculopathy, plexopathy, and peripheral neuropathy. Semin Pediatr Neurol. 2000;7(1):26–35.PubMedCrossRefGoogle Scholar
  70. 70.
    Ma J, Novikov LN, Kellerth JO, Wiberg M. Early nerve repair after injury to the postganglionic plexus: an experimental study of sensory and motor neuronal survival in adult rats. Scand J Plast Reconstr Surg Hand Surg. 2003;37(1):1–9.PubMedCrossRefGoogle Scholar
  71. 71.
    Chiu DT, Strauch B. A prospective clinical evaluation of autogenous vein grafts used as a nerve conduit for distal sensory nerve defects of 3 cm or less. Plast Reconstr Surg. 1990;86(5):928–34.PubMedCrossRefGoogle Scholar
  72. 72.
    Fawcett JW, Keynes RJ. Muscle basal lamina: a new graft material for peripheral nerve repair. J Neurosurg. 1986;65(3):354–63.PubMedCrossRefGoogle Scholar
  73. 73.
    Brunelli F, Spalvieri C, Rocchi L, Pivato G, Pajardi G. Reconstruction of the distal finger with partial second toe transfers by means of an exteriorised pedicle. J Hand Surg Eur Vol. 2008;33(4):457–61.PubMedCrossRefGoogle Scholar
  74. 74.
    Mackinnon SE, Dellon AL. Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube. Plast Reconstr Surg. 1990;85(3):419–24.PubMedCrossRefGoogle Scholar
  75. 75.
    Bushnell BD, McWilliams AD, Whitener GB, Messer TM. Early clinical experience with collagen nerve tubes in digital nerve repair. J Hand Surg Am. 2008;33(7):1081–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Bertleff MJ, Meek MF, Nicolai JP. A prospective clinical evaluation of biodegradable neurolac nerve guides for sensory nerve repair in the hand. J Hand Surg Am. 2005;30(3):513–8.PubMedCrossRefGoogle Scholar
  77. 77.
    Tung TH, Mackinnon SE. Nerve transfers: indications, techniques, and outcomes. J Hand Surg Am. 2010;35(2):332–41.PubMedCrossRefGoogle Scholar
  78. 78.
    Viterbo F, Trindade JC, Hoshino K, Mazzoni A. Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats. Br J Plast Surg. 1994;47(2):75–80.PubMedCrossRefGoogle Scholar
  79. 79.
    Artiaco S, Tos P, Conforti LG, Geuna S, Battiston B. Termino-lateral nerve suture in lesions of the digital nerves: clinical experience and literature review. J Hand Surg Eur Vol. 2010;35(2):109–14.PubMedCrossRefGoogle Scholar
  80. 80.
    Whitehouse WM, Coran AG, Stanley JC, Kuhns LR, Weintraub WH, Fry WJ. Pediatric vascular trauma. Manifestations, management, and sequelae of extremity arterial injury in patients undergoing surgical treatment. Arch Surg. 1976;111(11):1269–75.PubMedCrossRefGoogle Scholar
  81. 81.
    Mangat KS, Martin AG, Bache CE. The ‘pulseless pink’ hand after supracondylar fracture of the humerus in children: the predictive value of nerve palsy. J Bone Joint Surg Br. 2009;91(11):1521–5.PubMedCrossRefGoogle Scholar
  82. 82.
    Noaman HH. Microsurgical reconstruction of brachial artery injuries in displaced supracondylar fracture humerus in children. Microsurgery. 2006;26(7):498–505.PubMedCrossRefGoogle Scholar
  83. 83.
    Coombs CJ, Richardson PW, Dowling GJ, Johnstone BR, Monagle P. Brachial artery thrombosis in infants: an algorithm for limb salvage. Plast Reconstr Surg. 2006;117(5):1481–8.PubMedCrossRefGoogle Scholar
  84. 84.
    del Pinal F. Severe mutilating injuries to the hand: guidelines for organizing the chaos. J Plast Reconstr Aesthet Surg. 2007;60(7):816–27.PubMedCrossRefGoogle Scholar
  85. 85.
    Howe Jr HR, Poole Jr GV, Hansen KJ, Clark T, Plonk GW, Koman LA, et al. Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg. 1987;53(4):205–8.PubMedGoogle Scholar
  86. 86.
    Campbell DA, Kay SP. The hand injury severity scoring system. J Hand Surg Br. 1996;21(3):295–8.PubMedCrossRefGoogle Scholar
  87. 87.
    Grob M, Josty IC, Soldin MG, Dickson WA. Paediatric friction hand injuries caused by domestic vacuum cleaners-a review from one unit. Burns. 2003;29(7):714–6.PubMedCrossRefGoogle Scholar
  88. 88.
    Meyer TM. Psychological aspects of mutilating hand injuries. Hand Clin. 2003;19(1):41–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Royal Children’s HospitalMelbourneAustralia
  2. 2.St. Vincent’s HospitalFitzroy, MelbourneAustralia

Personalised recommendations