Streamlining the Management of Children with Simple Hand Injuries.

Hand injuries are common in children. Most simple pediatric hand fractures do not require surgery and can be treated with protective immobilization, yielding good outcomes. A recent institutional audit revealed significant practice variation in managing these children with many being overtreated with unnecessary follow-up visits. The objective of this study was to implement and assess a streamlined care pathway to manage "simple" pediatric hand injuries and minimize healthcare utilization. A single institution prospective study of the streamlined care pathway was conducted. Simple hand injuries included volar plate injuries, phalangeal Salter-Harris type 2 fractures, metacarpal neck fractures, unicortical and buckle fractures, proximal interphalangeal dislocations, and thumb ligamentous injuries. Patients were treated with either thermoplastic splinting or buddy taping. Standardized verbal and written instruction were provided. No routine follow-up was arranged. Participants were contacted by telephone 6 weeks post-injury to identify any concerns or need for follow-up. A total of 101 children with simple hand injuries were included. Sixty-one participants completed the telephone survey. About 90% had no problems during healing and 85% resumed all activities. Ten participants requested follow-up; however, 4 cancelled and the remaining 6 required reassurance with no additional treatment. Most simple pediatric hand injuries heal well with buddy taping or splint immobilization. The described streamlined hand pathway can avoid unnecessary follow-ups for simple pediatric hand trauma, reducing the burden on both families and the healthcare system.