Management of Pediatric Hand Injuries in the Acute Setting Part 1: Principles of Pediatric Hand Surgery Management.

Injury to the pediatric hand is common, yet acute management techniques are variable due to limited evidence-based guidance. The initial evaluation and treatment often falls to emergency department physicians, on-call orthopaedic surgeons, or primary care providers, who may lack specialized training or experience in pediatric hand injuries. The purpose of this three-part series is to provide education about the differences in management of pediatric hand patients, as compared to adult hand care. Additionally, it provides recommendations for the initial management of traumatic hand injuries in skeletally immature patients, guided by the literature where possible. This includes the management of urgent and emergent traumatic pathologies, including digital amputations and joint dislocations, in addition to common pediatric pathology. Key Concepts: (1)Pediatric-specific anatomy and physiology require different management strategies for hand injuries compared to adults.(2)Not all pediatric hand injuries will be okay without active management; early detection and referral can be crucial.(3)System-wide coordination among primary care, the emergency department, on-call orthopaedic surgeons, and hand specialists is essential for optimal management of pediatric hand trauma.