Hand Fractures in Children: When Do I Need to Start Thinking About Surgery?

Each year, a hand fracture is diagnosed in 24.2 of 100,000 children in Canada. Hand injuries are the most common fractures in children, making up approximately one fifth of all pediatric fractures. The incidence of hand fractures peaks between the ages of 10 and 14 years, with the highest frequencies observed among adolescent males. These increased frequencies coincide with the age at which most children begin playing contact sports, with sport-related injuries found to be the largest cause of adolescent fractures. The fifth digit is the most commonly injured digit, followed by the thumb. Phalangeal fractures constitute approximately 65% of pediatric hand fractures. Metacarpal fractures account for approximately 35% of pediatric and adolescent hand fractures, with 100 of every 100,000 children sustaining a fracture of the metacarpals. The decision to operate is related to many factors and depends on the age of the child and the location and nature of the fracture. The remodeling potential of pediatric bones factors largely into this decision because the phalangeal physis can contribute to bone growth and realignment via remodeling.