Carpal Tunnel, Boxer’s Fracture, Tennis Elbow, Arthritis, these are all conditions we associate with injuries or aging in adults. But what about the conditions that affect our children? In this blog we will be discussing the common hand problems seen in young children, both from injury and ones existing since birth.
Congenital issue refer to problems that are present at birth, aka a “birth defect”. While others conditions do exist, the three congenital hand conditions that we would consider to be the most common are Postaxial Polydactyly, Simple Syndactyly and Congenital Trigger Thumb. All of these conditions in children can be treated at Michigan Surgery Specialists by Dr. Emily Abbott and Dr. Mehul Mehta.
Postaxial Polydactyly– the presence of an extra pinky finger. This abnormality can be present in both the hands and the feet (hands being more prevalent). The extra growth can exist either as a complete finger, or as a large numb growing from the side of the hand, with or without bone. The old-fashioned way of removing this sixth digit was to tie a tread around it until the “finger” dies off. However, this could cause nerve damage or other issues to the hands. Our physicians prefer to perform the removal procedure operatively. While this procedure is considered non-emergent, the operation should take place when the baby is young, up to three months of age, so that they do not require much (if any) sedation. The older the child is, the more developed their nerves are, making sedation necessary.
Simple Syndactyly– refers to a finger webbing issue. In these cases, the child’s finger bones are normal, but the webbing between the fingers is too high. If the extended webbing is small (allowing the fingers to function independently without interruption), it can often be left alone. The higher the webbing is the more likely it needs to be addressed. In order to fix this problem, your specialist will need to surgically separate the fingers, which may also require a skin graft. Typically, the surgeon will wait to perform the procedure until the child is over 6 months of age so that the fingers are larger and more developed. Because of the possibility of a skin graft and the requirement of sedation, this procedure is generally performed in the OR rather than in office.
Congenital Trigger Thumb– much like trigger thumb in adults, parents may notice that their child cannot straighten their thumb all the way or it will make a pop when it does straighten. While this is considered a congenital condition since the child is born with it, parents may not notice the condition until the child is at least one year old. Sometimes children can grow out it, however those that don’t would require corrective surgery.
All of the following injuries can be treated by any of the hand surgeons at Michigan Surgery Specialists.
Tuft Fractures– this refers to a break in the bone at the tip of the finger. Kids typically injure this bone when slamming their fingers in a door. Since it is located at the top of the finger, nailbed injuries are also associated with this fracture. Luckily, these fractures often do not require surgery unless the nailbed needs to be repaired. Your child would just need to be splinted until the fracture heals.
Seymour Fracture– these fractures also take place at the tip of the finger, however these breaks take place though the growth plate. Much like Tuft Fractures, the break is generally associated with some type of crush injury. Treatment for this condition more often than not does require surgery as it tends to be an open fracture and requires repair to the nailbed.
Distal Radius Buckle Fracture– falling on an outstretched arm is a common case for this partial breaking in the bone at the base of the wrist. This condition is treated non-operatively most of the time with the physician opting for casting rather than surgery. Similarly, a Scaphoid Fracture (a break in one of the small bones in the wrist) can be caused by the same fall, but is seen more often in teenagers, as young children do not have the same bone development at that time. Non-surgical casting is still the go-to treatment method depending on the severity of the break.
Forearm Breaks– kids bones are considered “soft”, so it makes the Ulna and Radius a little easier to break. In kids, both long bones in the arm can often break at the same time. Falls and rough play are usually the culprit for this type of injury. For treatment, the need for surgery usually depends on severity of the break. If the bones are set (lined up) well then the child can often get away with just wearing a cast for a few weeks instead of having surgery.
How Does Treating Children Differ From Treating Adults?
While some of the treatment methods are the same, children do need some extra attention. Since the bones in children are not fully developed, their injuries and healing need to be monitored a little differently. If the injury affects a child’s growth plate, other issues could arise later, such as the affected bones growing in a different direction or early closure of the growth plates. When it comes to surgery, our specialists recommend using sutures that are absorbable so kids don’t need to worry about sutures being removed. This seems like a small detail, it does make all of the different to a scared child and a worried parent.
Getting The Help Your Child Needs
Most physicians will treat small children for injuries they experience while playing, but this generally affects the two and older population. There is only small handful of hand specialists in the Metro-Detroit area that will treat children younger than two for injuries AND congenital disorders, luckily our practice has two! If your child is experiencing a hand injury or illness that needs specialized attention, schedule an appointment with Dr. Emily Abbott or Dr. Mehul Mehta!