Paediatric hand surgery: a guide for parents

Distinguished consultant plastic, cosmetic and hand surgeon Miss Kerstin Oestreich discusses the most frequent paediatric hand surgery conditions, how they are treated and risks linked to such surgeries.

What are the most common paediatric hand surgery conditions?

In paediatric hand surgery, the type of injury is very much dependent on the age of the child. For very young children and toddlers, the most common injury is a fingertip injury caused by getting fingers caught in doors. As children grow older and engage in sports, they are more likely to experience finger fractures, hand lacerations, or tendon injuries, though tendon injuries are less common.

Beyond trauma, trigger finger is a frequent condition in children aged one to five. Ganglion cysts in joints are also common. Additionally, congenital hand differences, such as having extra or fewer fingers or hand contractures, represent a significant portion of paediatric hand surgeries. These congenital conditions can vary widely and require specialised surgical attention.

How are paediatric hand surgery conditions treated?

Treatment options also depend on the age of the child and the type of condition being treated. The main options are either conservative treatment with hand therapy, splinting or surgery. For example, when treating a trigger thumb in young children, we initially opt for conservative treatment, using stretches and splinting for six to twelve weeks. If the condition doesn't improve, we then consider surgery. Some traumatic injuries, such as fingertip injuries, often require surgical intervention, including a washout and sometimes repair. In contrast,  ganglions can sometimes be managed conservatively if they are asymptomatic and merely visible without causing discomfort. However, if a ganglion becomes bothersome, surgery may be necessary.

What are the most common risks related to paediatric hand surgery?

In hand surgery, particularly for children with congenital hand conditions, the primary concern is balancing hand function and appearance. Deciding whether normal appearance or optimal function is more important involves thorough discussions with the family. For non-congenital issues, like ganglions or trauma, ensuring the child's compliance with treatment is crucial. Younger children, around three years old, may not understand instructions, so protective measures and dressings are essential. Teenagers, on the other hand, can comprehend and follow instructions better.

A significant challenge in paediatric hand surgery is managing this compliance, along with the inevitability of visible, long-term scars, especially on the hands. It is important to communicate clearly with the family about the permanent nature of these scars and their visibility. Balancing these factors is critical in providing the best possible outcome for the child's hand function and appearance.

How can parents prepare their children before facing paediatric hand surgery?

For very young children, toddlers up to around five or six years old, their understanding is limited to knowing they are visiting the hospital and seeing the doctor. Our focus is on ensuring the dressing is secure and the splints fit properly, so the child cannot remove them. We use play therapists to distract and comfort the children during this process.

With older children, we can provide detailed explanations to help them understand what to expect, which reduces their fear. Parents can also help by discussing the process at home, addressing any fears and anxieties, and reassuring their child that while they might have a dressing, they likely won’t experience pain. This helps prepare the child and make them more comfortable with the treatment.

How is the recovery process of these surgeries and is there any special recommendation that we can give to parents?

Children heal much faster than adults, so a hand laceration in a child can heal within 10 days, whereas it takes longer for adults. Consequently, children typically require fewer dressing changes. We aim to minimise these changes as much as possible because they can be stressful, painful, and anxiety-inducing for the child.

We ensure the dressings and splints are secure and well-fitted. Additionally, we avoid immobilising the child longer than necessary. Children are naturally resilient; if it doesn't hurt, they will use their hand as much as possible. If needed, hand therapy is available to support their post-surgery recovery. Overall, children's recovery is quicker, and they are quite adept at healing themselves.

If your child requires hand surgery, you can book a consultation on their behalf via Miss Oestreich’s Top Doctors profile today