Abstract Hand injuries account for a significant proportion of pediatric injuries and carry the risk of long-term functional impairment. This article provides a structured overview of common injury patterns, including fractures as well as tendon and nerve injuries, and discusses specific aspects of treatment in children.
Abstract Proximal humerus fractures are rare in pediatrics. The shoulder x-ray is the diagnostic gold standard, allowing classification according to AO or Neer and Horowitz. Non-operative and operative treatments can be followed but a clear guideline for treatment selection is missing. We observed that most of the fractures can be treated non-operative due to the high growth potential of the proximal humerus. Fractures which are open, feature a neurovascular system damage, show a higher grade in dislocation, or present in polytraumatic or older children with limited growth potential should be treated operative. In these cases, a closed reposition and K-wire fixation or intramedullary nailing might be sufficient and provide a less invasive option. However, if this is unsatisfying, an open reduction and internal fixation with locking plates are needed.
With the increasing number of primary knee prosthesis implantations and the demographic changes, the number of periprosthetic fractures is also rising. Their treatment often proves to be challenging.Standard diagnostics consist of conventional X-rays with a calibration object. For prosthesis planning, the adjacent joints should also be image, x-rays of the contralateral side can be helpful. The imaging is usually supplemented by a CT scan to better assess the prosthesis fit and bone quality. Based on the imaging, the fracture can be classified according to Rorabeck or UCS, although the prosthesis fit cannot always be definitively determined. The prosthesis model and implantation date should be identified, ideally through the implant pass and surgical report.In surgical treatment, osteosynthesis aiming to preserve the prosthesis should be attempted, if technically feasible. Indications for a prosthesis exchange include loose prosthesis, a well-fixed prosthesis with poor or reduced bone quality that does not provide sufficient fixation for osteosynthesis, fractures with a high risk of pseudarthrosis, ligamentally unstable prosthesis, or periprosthetic fractures in geriatric patients, when an osteosynthesis doesn’t allow primary full weight bearing. However, due to limited data, no general recommendation or algorithm can be provided; decisions must be made on a case-by-case basis.Until definitive treatment, temporary immobilization with an external fixator may be necessary. Technically, a prosthesis exchange is a complex operation consisting of four main steps: patient in dorsal decubitus and medial arthrotomy, resection of the distal femur and preparation of the femoral canal, removal of the tibial component and tibial preparation, followed by determination of the prosthetic components and implantation.The particular challenge lies in correctly restoring the joint line and especially the femoral rotation.The complication rates and outcomes do not differ significantly from osteosynthesis according to several current reviews and meta-analyses.
