Operative treatment of fractures and dislocations of the hand and wrist region in children.

The indications for open treatment of skeletal injury of the pediatric hand and wrist region are limited, but failure to surgically treat these fractures and dislocations will cause later morbidity. Irreducible dislocations of the small joints of a child's hand require open reduction. Angulated fractures of the middle and proximal phalanx in the region of the neck or distal shaft also require exact reduction because of the poor remodeling capacity in that region. Irreducible Salter-Harris II fractures of the distal radius and unstable Galeazzi type fracture-dislocations of the distal radius in the older child should also be treated using open methods if a satisfactory closed reduction cannot be obtained. All treatment recommendations are based on limited case reports, and the surgeon treating such rare injuries should review the limited pertinent literature before beginning treatment of these rare injuries.