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Background: The frequency, pattern and treatment of pediatric hand fractures are largely underreported. We sought to review our institution experience with management of hand fractures in children and adolescent.

Methods: A retrospective review of all children (under 18 years of age) treated for hand fractures between January 1990 and June 2017 was performed. Fractures were categorized into metacarpal, proximal/middle phalanx, distal phalanx, and intra-articular MCP/PIP/DIP joints fractures.

Results: During the study period, 4356 patients (71% male) were treated for hand fractures at a mean±SD age of 12.2±3.5 years. The majority of fractures occurred in patients aged 12-17 years (n=2775, 64%), followed by patients aged 6-11years (n=1347, 31%). Only 234 (5%) fractures occurred in children younger than 5 years. Most fractures occurred in the middle/proximal phalanx (n=2103, 48%), followed by metacarpal (n=1431, 33%), distal phalanx (n=521, 12%), and intra-articular MCP/PIP/DIP joints fractures (n=301, 7%). Middle/proximal phalangeal fractures were the most common fractures in all age groups.

In patients between 0-5 years, distal phalangeal fractures were the next most common, while in patients older than 5 years metacarpal fractured were the next most common. The frequency of metacarpal fractures increased gradually with age and reached a frequency similar to that of middle/proximal phalangeal fractures in the 12-17 years age group.

The majority of metacarpal (93%), middle/proximal phalangeal (92%), and distal phalangeal (86%) fractures were amenable to closed treatment alone, whereas 28% of intraarticular MCP/PIP/DIP joint fractures required open reduction +/- fixation

Conclusion: The frequency, pattern, and treatment of pediatric hand fractures vary according to age. The large majority of fractures were amenable to closed treatment although intraarticular fractures were more likely to require operative intervention.