Child Hand and Wrist Injuries: A Guide for Parents
The hand is the most commonly injured part of the body in children. The treatment of fractures in children differs from that in adults because children's bones are constantly growing. This growth is a great advantage, as it can correct many post-fracture malpositions on its own.
Most common types of injuries
Fingertip injuries: Getting a finger caught in a door is a typical accident for young children. Even if there is a fracture, the most important thing is often to check the condition of the nail bed and possibly repair it.
Fractures of the base of the fingers and metacarpal bones: Injuries are common in older children, and are most often treated without surgery with taping, a splint, or a cast.
Fractures of the wrist area: Fractures of the lower part of the radius, especially those caused by falls, are very common.
Fractures requiring special attention
Some types of fractures are insidious and almost always require specialist treatment or surgery:
Seymour's fracture: A fracture that goes through the growth line of the tip of the finger, where the nail root may remain in the fracture gap.
Fracture of the neck of the finger member: The broken part can rotate up to 180 degrees. If left untreated, this will permanently limit the ability to bend the finger.
Intra-articular fractures: Often require surgery to make the joint surface completely smooth.
Twists (rotational errors): Unlike angular errors, growth does not correct the curvature of the bone. Therefore, it is important to check that the fingers bend in the correct direction when bent (the nails point in the same direction).
Types of wrist fractures and their treatment
The doctor will determine the type of fracture based on the X-ray. The treatment depends on the type of fracture:
| Fracture type | Description | Typical treatment |
| Torus fracture | ”Wrinkling” of the bone shell, a stable injury. | A support bandage, splint or cast mainly for pain management. |
| Greenstick (willow stick) | The bone only breaks on one side and bends. | Repositioning (reposition) and plastering. |
| Cross fracture | The bone is completely broken, often with shortening. | Straightening and plastering. |
| Growth line fracture | The fracture extends to the line corresponding to the growth of the spine. | Careful positioning; avoiding unnecessary attempts to secure growth. |
The importance of growth in recovery
The child's age is a decisive factor in treatment:
Under 10 years old: The potential for skeletal repair (remodeling) is excellent. For example, in the wrist, a significant angular error (up to 30–35 degrees) can be tolerated because growth straightens the bone over time.
Over 10 years old and teenagers: There is less growth left, so the position of the fracture is more precise. Treatment approaches the principles of adult treatment.
When is surgery needed?
Although most injuries heal with a cast, surgery (e.g., small stitches or opening) is needed if:
There is a notch on the articular surface.
The fracture has a significant torsional error.
The fracture position is so unstable that it cannot be held in place with a cast alone.
This is a growth line injury that threatens the normal growth of the bone in the future.
Pediatric Hand Surgery Review of Hand Injuries (2014 Version)
https://bin.yhdistysavain.fi/1607320/KmxJWwsTh84H17vAox0p0Y0pGK/sot1-14_lasten_kaden_ja_ranteen.pdf