Pediatric Distal Radius Fractures

• In this case, two 8-year old female patients fell off a jungle gym and showed signs of swelling or tenderness around the distal radius, with no further injuries.

• After performing x-rays, the first patient had a buckle fracture, and the second patient had a Salter-Harris fracture (type 2).
• Since buckle fractures are inherently stable (without any serious risk of displacement), the treatment procedure followed for the first patient was using a removable brace for 2-4 weeks.
• However, the second patient required treatment that involved possible reduction, casting, and returning check-ups until an x-ray reveals normal growth.

• After treatment, the first patient did not have any further issues with the hand. However, the second patient returned after 18 months with a large bump on her ulnar wrist.

Closed Mallet Thumb

• The closed mallet thumb injury recorded involves a female caucasian aged 28 years. She sustained the injury in an accident with her horse. The horse rein wrapped around her dominant right thumb while the animal pulled at it in different directions, leading to a hyperflexion trauma.
• After physical examination, the integument of the injured thumb was still intact. There was a 30-degree flexion on the interphalangeal (IP) joint and severe local pain.
• Functional testing revealed an inability for active extension of the IP joint. Following passive IP joint extension, the patient was unable to maintain its full extension.
• Otherwise, the IP joint was stable and didn't show any fractures. "The metacarpophalangeal (MCP) joint of the affected thumb was compromised in its physiological range of motion (ROM) due to the pain but unharmed. No other combined injuries were observed."

• The clinical diagnosis for the patient was a "closed rupture of the extensor pollicis longus (EPL) tendon." Following an ultrasound examination, the decided course of treatment was surgical.
• The surgery involved the use of wide-awake anesthesia, an H-shaped "dorsal incision centered on the IP joint." It also required the anatomical reinsertion of the tendon.
• Since a suture was not possible due to the rupture location, the reconstruction procedure took place using a "Mini QUICKANCHOR® suture anchor."
• "Additionally, the IP-joint was transfixed with a Kirschner wire (1.25 mm) in full extension to ensure immobilization during the initial healing process."
• Postoperative recovery followed due process with immediate hand physiotherapy, followed by "active mobilization and increased weight-bearing."
• Eight weeks after the surgery, the patient was exposed to unrestricted load and full mobilization.

• The patient recovered fully with a Kapandji score of 9 (normal) and 7kg pinch strength.

Summary

• The information available for hand injuries is quite substantial. However, treatment methods may vary depending on the case. There also appear to be standard procedures for certain hand injuries.
• Hand injuries may be resolved with or without further complications depending on a variety of factors.