Pediatric emergency medicine trisk 3337 3337
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CHAPTER 109 ■ HAND TRAUMA
ANDREW F. MILLER, CARLEY VUILLERMIN
GOALS OF EMERGENCY CARE
Hand trauma is common in the pediatric emergency department, with a broad
spectrum of clinical presentations. Injuries include fractures, sprains and soft
tissue injuries, nail bed injuries, and lacerations. Understanding the anatomy,
injury patterns, and necessary management and referral for ideal recovery of the
hands is vital for future function. Further, the provider should recognize that
injury to the hands can result from nonaccidental trauma and be vigilant for
related findings and concerns.
KEY POINTS
Topographic anticipation (i.e., recognizing the vulnerable anatomy at
the site of injury) can aid the clinician in predicting the injury and
potential structures disrupted.
Lacerations and soft tissue injuries are more common in younger
children and fractures are seen more frequently in older children.
Thorough examination should include a visual inspection, assessment
of the general alignment of the hand and digits ( Fig. 109.1 ), focused
palpation, passive and active range of motion across each joint ( Fig.
109.2 ), and a neurovascular assessment.
Absorbable sutures are equally effective in fingertip wound repair and
require less intervention on follow-up.
A finger splint is not adequate immobilization for proximal phalanx
fractures; a hand- or forearm-based splint is more appropriate.
Skin wounds obtained during an altercation (“fight bites”) represent a
high-risk injury with a high incidence of infection due to human oral
flora.
Clinical vigilance is required for possible scaphoid fractures or carpal
ligamentous injuries as long-term issues can arise from inadequate
care.
FINGERTIP INJURIES
