Clinical outcomes from nonoperative management of pediatric metacarpal and phalangeal fractures: A scoping review.

Abstract

Background: Pediatric hand fractures are often managed nonoperatively, however literature comparing the outcomes of various nonoperative approaches is scarce. Nonoperative management approaches such as plaster cast immobilization and thermoplastic orthoses, are typically chosen when surgery is not indicated or necessary. Comparing the effectiveness of nonoperative management practices is crucial for enhancing pediatric hand therapy.

Purpose: The objectives of this review were to: (1) consolidate and evaluate research on nonoperative management of pediatric hand fracture management; (2) identify trends, gaps, and opportunities within this body of research; and (3) highlight areas for future research and the development of clinical guidelines.

Study design: Scoping review.

Methods: An extensive database search was conducted via AMED, CINAHL, Global Health, Health Source: Nursing/Academic Edition, MEDLINE Complete, MEDLINE, and Open Dissertations. Included studies recruited children and adolescents aged 0 to 18years receiving nonoperative management for metacarpal and phalanx fractures. Data were extracted and synthesized narratively, focusing on key characteristics and emerging themes.

Results: Only three peer-reviewed studies met the inclusion criteria, highlighting a significant lack of high-quality research. Clear clinical guidelines were not reported, and the included studies varied in their methodology, sample size and outcome measures. All studies emphasized the need for more rigorous and comparative research to establish effective management strategies.

Conclusions: This scoping review highlights the critical need for comprehensive, comparative studies in pediatric hand fracture management. The evidence base is limited and fragmented, underscoring the necessity for rigorous clinical guidelines and the development of multicenter trials to optimize care for pediatric patients.