Pediatric Upper Extremity Disorders
Upper extremity disorders in the pediatric population present unique problems and situations. In pediatrics, the conditions are quite different, the disposition of the patient is quite different, and consequently the management by the hand surgeon is uniquely different.
Fractures
The growing skeleton can be equally forgiving and unforgiving. Long bone fractures in children have tremendous ability to remodel and spontaneously correct any resultant deformity.
On the other hand, fractures that involve the growth cartilage can cause premature growth arrest of the involved bone, causing progressive deformity as the child continues to grow. Furthermore, since the growth cartilages is in close proximity to the joint, sprain-like injuries, may actually be a potentially disabling fracture which extends into a joint. Therefore, an understanding of the mechanism in these various injuries and their natural history is a prerequisite to their proper surgical or conservative treatment.
The innocent irresponsibility of young children makes compliance with treatment often difficult. Dressings, splints and casts must be applied more securely and carefully. Fortunately, youngsters can tolerate protracted periods of immobility with less adverse effects. However, in some complex injuries such as flexor tendon laceration, surgical reconstruction may have to be delayed until the child becomes older.
Cerebral Palsy
From a pragmatic point of view, cerebral palsy is the pediatric counterpart of the adult stroke or head injury. As in the adult stroke patient, the presence or absence of reasonable intelligence, and body awareness determines the realistic goals of surgical and non-surgical treatment.
The precise determination of spastic involvement of muscles is of paramount importance in planning successful surgery. Through such careful determination, the appropriate weakening of such spastic muscles by lengthening procedures or augmenting function by transferring these muscles is possible.
Congenital Deformities
The management of congenital deformities presents perhaps the most challenging technical problem for the hand surgeon. The numerous presentations can require extensive skin, tendon, and bone reconstruction to achieve an acceptable functional as well as cosmetic result. Perhaps more important than the surgical reconstruction of the involved limb is the recognition of the various potentially health-endangering organ abnormalities that often accompany such deformities. In such cases, the appropriate referral to and management by the pediatrician and related specialists take precedence over surgical or non-surgical consideration of the involved hand or arm.