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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.
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