Artikel
Paediatric Carpal Injuries: Proposal of a Clinical Management Protocol
Suche in Medline nach
Autoren
Veröffentlicht: | 10. Oktober 2017 |
---|
Gliederung
Text
Objectives: Carpal fractures in children are uncommon. Challenges in their management are compounded by their often non-specific clinical symptoms, occult nature on plain radiography and the potential for concomitant soft tissue injury. In one retrospective case series of 61 children with suspected carpal injury, initial plain radiography yielded 3.3% rate of diagnosis for carpal fractures, and MRI performed in cases of persistent symptoms (54%) demonstrated carpal fractures including bone bruise lesions in 63% of those imaged. Soft tissue injuries and persistent symptoms in the absence of radiologically defined carpal fractures were not discussed.
We prospectively developed a protocol for the treatment of carpal injuries in children, encompassing bony and ligamentous injuries. This protocol will be presented in detail and feedback welcomed.
Method: Within our hand trauma unit, approximately 120 children with wrist trauma were managed over a three-year period by one consultant. Anecdotally, we recognised that there is a cohort of children whom present with persistent pain following wrist trauma with no radiological evidence of bony or ligamentous injury. Within this cohort, a proportion had marked joint laxity or hypermobility syndrome. Current management of those with suspected carpal injuries are considered on a case-by-case basis.
Results: In particular, the protocol identifies children with persistent pain following trauma with no radiological evidence of bony or ligamentous injury on MRI. Within this subgroup, management is considered for those with hypermobility syndrome and marked joint laxity.
Children presenting with marked joint laxity and persistent pain, would be offered hand therapy. If symptoms persist despite six months of treatment, diagnostic arthroscopy, synovectomy and possible shrinkage would be discussed.
In selected cases of children with hypermobility syndrome and painful wrists, including the absence of gross trauma, persistent symptoms may reflect repetitive micro-trauma. In this group, if refractory following 9 to 12 months of non-operative treatment, we will manage similarly to those symptomatic with marked joint laxity.
Conclusion: A standardised treatment protocol can be a valuable tool in the management of children with wrist trauma in the early and medium-term. Our aim is to implement the peer-reviewed protocol and assess its validity through prospective auditing of patients' care pathway and outcomes of their carpal injuries.