CHAPTER 109 ■ HAND TRAUMA ANDREW F MILLER, CARLEY VUILLERMIN GOALS OF EMERGENCY CARE Hand trauma is common in the pediatric emergency department, with a broad spectrum of clinical presentations Injuries include fractures, sprains and soft tissue injuries, nail bed injuries, and lacerations Understanding the anatomy, injury patterns, and necessary management and referral for ideal recovery of the hands is vital for future function Further, the provider should recognize that injury to the hands can result from nonaccidental trauma and be vigilant for related findings and concerns KEY POINTS Topographic anticipation (i.e., recognizing the vulnerable anatomy at the site of injury) can aid the clinician in predicting the injury and potential structures disrupted Lacerations and soft tissue injuries are more common in younger children and fractures are seen more frequently in older children Thorough examination should include a visual inspection, assessment of the general alignment of the hand and digits ( Fig 109.1 ), focused palpation, passive and active range of motion across each joint ( Fig 109.2 ), and a neurovascular assessment Absorbable sutures are equally effective in fingertip wound repair and require less intervention on follow-up A finger splint is not adequate immobilization for proximal phalanx fractures; a hand- or forearm-based splint is more appropriate Skin wounds obtained during an altercation (“fight bites”) represent a high-risk injury with a high incidence of infection due to human oral flora Clinical vigilance is required for possible scaphoid fractures or carpal ligamentous injuries as long-term issues can arise from inadequate care FINGERTIP INJURIES