paediatric hand trauma: fractures - royal children's hospital · •mallet finger zone i-ii...
TRANSCRIPT
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Paediatric Hand Trauma:
- Tendon injuries
Occupational Therapy Department
The Royal Children’s Hospital
Melbourne, 2014
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• Incidence & common injuries
• Paediatric specific considerations
• Flexor tendon treatment – A guide
• Extensor tendon treatment – A guide
• Occupation in therapy
Presentation outline
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Incidence & common injuries
• Lacerations are one of the
highest occurring injuries of the
hand in the 1-2 year old age
group
• Often lacerations to the hand,
wrist or forearm can result in
tendon damage
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Paediatric Specific Considerations
• Healing time frames
• Impact of growth
• Inability to specify or verbalise pain
• Behaviour and occupations
• Mobility - stiffness is not usually an issue
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Tendons – treatment
Goals of therapy:
• Protect healing tendon
• Return to normal hand function
Considerations:
• Healing faster in children than adults
• Prone to hypertrophic scarring – long term influence
of scar
• Compliance limited by developmental and
behavioural factors
• Ability to follow rehab instructions
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Flexor tendons
• Most common injury site - Zone II
• Most commonly occurs in three year old children
• Increased surgical difficulty in very young
patients – reduced number of core suture
strands, decreased repair strength, sacrifice of
FDS
• Paediatric treatment is different to treatment in
adults
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• Evidence supports immobilisation for up to 4 weeks
following a flexor tendon repair, in splint or plaster
Age Considerations
School aged children Children under 6
Splint or Plaster Plaster
Wrist: neutral
MCPJ:
40-90˚ flexion
IPJ: neutral
Elbow: 90 ˚ flexion
Wrist: neutral
MCPJ: 40-90˚ flexion
IPJ: neutral
Flexor tendon treatment: A Guide
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Flexor tendon treatment: A Guide
Week 1-4 Immobilisation
Week 3-4 Synergistic wrist and digit motion
Week 4-6 Cease splint/high risk tasks only
Differential tendon glide
Light functional hand use
Week 6 Extension splinting (if required)
Extension stretches
Week 8-12 Resisted exercises
Return to full activity
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Considerations
• Very few problems with stiffness
• Tape beneath splint for skin
protection and tape splints on to
secure them
• Risk of mouthing / removing /
swallowing small splints
• Generally managed with
immobilisation approach
Extensor tendon treatment: A Guide
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• Mallet Finger Zone I-II
Immobilise: DIPjt extension for 6-8 weeks
• Central Slip Zone III-IV
Immobilise: PIPjt extension for 4-6 weeks
• Proximal zones V-VIII
Immobilise: all digits & wrist in extension
for 4 weeks
• 6-12 weeks – gradual return to flexion,
functional hand use and resisted exercises
Extensor tendon treatment: A Guide
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Therapeutic games and activities
- general ideas for therapy
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Flexion
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Extension
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Thumb
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Occupational Therapy DepartmentThe Royal Children’s Hospital
Flemington RoadParkville 3052
Phone (03) 9345 9300
With thanks to Tanya Cole and Josie Duncan