Problematic Pediatric Hand and Wrist Fractures.

Seymour fractures are open juxta-physeal fractures of the distal phalanx. A true lateral radiograph should be obtained for diagnosis, and treatment should include removal of the nail, irrigation and debridement of the fracture, and percutaneous Kirschner wire stabilization. Mallet fractures are more common in children than adults, and treatment is generally nonoperative for nondisplaced or minimally displaced fractures without volar subluxation of the distal phalanx; however, splinting compliance should be carefully assessed in younger populations. Phalangeal neck fractures have a limited potential to remodel and a propensity to redisplace. A true lateral radiograph will show displacement best; treatment is generally with percutaneous pinning. Open reduction should be avoided when possible because of the risk of osteonecrosis of the phalangeal condyles. The epidemiology of scaphoid fractures in children is changing, with waist fractures now the most common type. This may be due to an increase in body mass index (BMI) as well as high-level sports participation in today's pediatric population. Although the vast majority of acute scaphoid fractures can be treated successfully with cast immobilization, children who present with established nonunions should be offered open reduction and internal fixation as the primary treatment.