As so many of children’s interactions with the world are through their hands, it is no surprise that hand injuries are a common pediatric complaint. Fractures of the hand and wrist account for 2.3% of pediatric emergency department visits, with a peak incidence in the teenage years, coinciding with participation in sports or fights. Hand injuries may be subtle, and appropriate recognition, treatment, and referral are vital for preventing long-term morbidity.
After a focused history, providers should inspect for edema, ecchymosis, laceration, or deformity and assess all joints for motor function in addition to active and passive range of motion. The examiner should evaluate sensation and capillary refill, particularly distal to the injury. Any sensorimotor abnormality should raise concern for tendon or nerve involvement. Bony anatomy should be meticulously palpated, with any point tenderness or crepitus evaluated for fracture.
The distal phalanx is frequently fractured in toddlers, with peak incidence...
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