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A finger injury is among the most common musculoskeletal reasons for primary, orthopedic and emergency care consultation; the incidence of pediatric
hand fractures has been cited as high as 26.4 per 10,000.
In toddlers and young children, the injury is most often a crush mechanism; in older children, the injury is commonly due to participation in sports. Fortunately, up to 75 percent of all pediatric hand injuries heal well without long-term negative
consequences. The trick is to identify the problematic injuries and decide when to seek consultation.
Many injuries are "jammed fingers,"a soft tissue stretch or tear of the peri-articular structures around the proximal interphalangeal joint that will heal quickly with buddy taping.
If the finger is acutely crooked, even subtly, has marked limits of range of motion passively or actively, or droops, and the child has an inability to properly position it, then a radiograph and urgent referral is necessary. If the finger, wrist or hand remains swollen, stiff or painful beyond several days to a week of home observation, then a radiograph is necessary.
All fractures should have consultation to differentiate the benign fractures from the 25 percent that need operative intervention. Early referral is ideal. Fortunately, most fractures, tendon
disruptions and ligament injuries can be repaired up to two weeks after the injury without problems.
Crush injuries that involve a nail bed laceration require careful repair to prevent long-term nail plate deformity. Lacerations and crush injuries with poor blood supply require emergent referral.
Lacerations that extend through the dermis (fat or even deeper structures showing in the wound) require emergent cleansing and closure. Glass lacerations can cause only a minimal-length skin laceration but penetrate deeply to cut underlying tendons and nerves. Any glass laceration requiring sutures needs a thorough, isolated exam of each nerve and tendon in the anatomic region. All too often, these children present weeks and months after the sutures have been removed and are in need of reconstructive surgery.
Our urgent care clinic and trauma service are available for patient evaluations.
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