Rockwood, Green, and Wilkins' Fractures, 10e Package

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SECTION ONE • Fundamentals of Pediatric Fracture Care

B

A

D

C

E

F

Figure 6-5. This 7-year-old patient fell while riding a bicycle, sustaining an ipsilateral displaced SCH fracture and distal radius fracture. He was seen about 4 hours after his initial injury. He was diagnosed with a compartment syndrome on presentation and taken emergently to the operating room for surgical stabilization and fasciotomy. A: Injury films showing displaced SCH fracture and distal radius fracture. B: Postoperative reduction and stabilization. C: Volar fasciotomy. D: Dorsal fasciotomy. E: Finger flexion at 1-year postinjury. F: Wrist and finger extension at 1-year postinjury. (Courtesy of Dr. M. Stevanovic.)

structures. Definitive wound closure should be performed only after swelling has considerably decreased. In the hand, only the incision for the carpal tunnel release should be considered for delayed primary wound closure. The other palmar and dorsal incisions as well as the dermotomy incisions will close quickly by secondary intention. If the skin cannot be closed without tension, then split-thickness skin grafting with or without dermal substitutes should be used. Therapy should be started immediately postoperatively to maintain maximum active and passive ROM of the fingers. Splinting should be done as long as needed for soft tissue sta bilization or for treatment of other associated injuries. Therapy may need to be temporarily discontinued during healing of skin grafts but should be resumed as soon as tissue healing allows. Once the soft tissues are adequately healed, continue night time splinting to prevent contractures of the wrist and fingers. Splinting is continued until scars and soft tissues are mature and supple.

Figure 6-6. Cross-sectional anatomy of the hand. The arrows show the planes of dissection for decompression of the compartments of the hand. (Courtesy of Dr. M. Stevanovic.)