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Ligament tears, mallet fingers most common hand, wrist injuries seen in young athletes
Surgeon warns against the debridement of central triangular fibrocartilage complex tears in children.
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LAS VEGAS — The epidemiology of wrist and soft tissue injuries of the hand are changing as children enter highly competitive level sports at earlier ages.
Peter M. Waters, MD, said that most wrist pain in these patients results from overuse, accelerated growth problems and ligamentous laxity, and many patients have normal results on imaging exams.
Although most patients respond well to strengthening programs and return to full activities at 6 to 12 weeks, he said that about 20% of his patients have more serious problems such as chondral impingement, scapholunate ligament tears, distal radioulnar instability and triangular fibrocartilage complex (TFCC) tears, he said in a presentation to the American Academy of Orthopaedic Surgeons meeting.
Arthroscopy can be used to identify and treat specific injuries, although you should not scope everyone who is negative in their work up, he said. Indications for arthroscopy include scapholunate ligament injuries, osteochondral lesions, TFCC tears and intra-articular distal radius and scaphoid fractures.
Classification
Using the Palmer classification can help surgeons choose the appropriate treatment for TFCC tears, he said. “TFCC tears in kids are most common on the periphery, and you can repair this with an outside-in technique.”
Waters warned against debriding radial-sided tears. Instead, he recommended that surgeons perform a trans-radial repair for these tears.
Distal radio-ulnar instability is also an issue in young athletes. “If you have an unstable distal radial joint and it is related to a malunion, do an osteotomy and that will solve most of the problem,” Waters said. Patients with soft tissue or combination injuries should undergo repair, he added.
Hand injuries
Physicians may see mallet injuries, jammed fingers, Jersey fingers and injuries to the metacarpophalangeal (MCP) joint in the hand. Most mallet injuries are transphyseal problems, Waters said, alerting surgeons to the Seymour entrapment. Surgeons should not mistake Seymour fractures for mallet injuries and attempt to splint the fracture.
The optimal treatment for chronic mallet fingers remains unclear, he said. However, severe mallet injuries should undergo operative repair.
For more information:
- Peter M. Waters, MD, can be reached at Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115; 617-355-4849; e-mail: peter.waters@tch.harvard.edu. He has no direct financial interest in any product or company mentioned in this article.
Reference:
- Waters, PM. Wrist ligamentous injuries and hand injuries. Symposium V: Upper extremity injuries in pediatric sports. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-27, 2009. Las Vegas.