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Lindley Wall, MD (Guest):   Hello. I'm Dr. Lindley Wall. I'm a Washington University orthopedic surgeon with St. Louis Children’s Hospital and I'm a mom doc.

Melanie Cole, MS (Host):   Hey, welcome to Mom Docs, the podcast from St. Louis Children’s Hospital. Today we’re talking about hand and wrist injuries and how they're treated. Dr. Wall, it’s a pleasure to have you with us today. Tell us about some of the conditions that you treat at St. Louis Children’s Hospital. What are some of the most common sports injuries of the hand and wrist that you see?

Dr. Wall:   You know we see a wide range, as you can imagine, from really little kids to teenagers. So the conditions that affect them do range dramatically. Our little kids come in, a lot of finger tip injuries. A lot of balls being thrown causing little finger fractures and thumb injuries. Then as our kids get older it kind of ranges. Currently, as you can imagine, in the summer time we see a lot of trampoline injuries, a lot of wrist fractures occur with that. Then hopefully as our sports start to ramp up, the kids will get out there playing. Unfortunately, it also leads us to more injuries such as finger injuries and wrist fractures with football and soccer and basketball. Kind of a whole range, but the fingers are very exposed and often times get bent back the wrong direction. Then the wrists usually get injured more from falls or impact.

Host:   So do you see mostly acute injuries, Dr. Wall, or are you also seeing chronic injuries? When you're talking about sports and kids, there are chronic injuries that can happen with baseball and just all of those kind of things. Also with our kids, thumbs, texting, overuse injuries. Are you seeing those as well?

Dr. Wall: Good question. Absolutely we see a lot of acute injuries. So those are the ones that they come in within a week or so. They usually have been seen in an emergency room or an urgent care. Those come in and we’re able to kind of treat them acutely. A wide range of treatment—casting or bracing or sometimes surgery. We also see the chronic injuries. Those can kind of range from a strain or a ligament injury or even a fracture. We’ve got a lot of tough kids that kind of play through things. So we don’t see some finger fractures or some wrist injuries for weeks or even a couple months out. So those can sometimes be a little bit harder to deal with. We definitely see all of it. A little bit less so with the texting. While I completely agree, potentially over time that will cause us some problems. So we’re not seeing so much of that now.   

Host:   So then speak about treatments. Things that you're doing there and the services that you offer. Speak first about non-surgical options. We don’t always think of hand therapy, physical therapy, occupational therapy. Tell us a little bit about some of the non-surgical things you can try with kids that have hand injuries.

Dr. Wall:   So our first evaluation is really to see if hopefully we can treat most of our injuries without surgery. So for example, if you have a child with a small finger fracture, our goal is to evaluate, ensure that the overall alignment is going to be functional for them over time. So fingers when they get broken, they usually aim in a different direction or they're angled too much. So there's a range in which we can accept that overtime it will heal, and the children will function well. So that’s our goal. So most of the time we can accept a little bit of angle. We know that some kids, especially the young kids, finger in the bones will straighten out over time because they have open growth plates and the fingers, and the bones are still growing. So we can treat them in a cast easily or even in a brace. I have fantastic hand therapists that work with me, and they are really good at making smaller braces and even braces that kids can swim in. So that’s become very helpful, especially in the summer time. If you have a finger fracture, say we do a couple weeks in a cast. It has enough healing so it’s stable. Then we can kind of transition into a removable brace which will allow them to swim, but they can come out for showering and they can come out to start working on motions so they don’t get stiff. So that’s a really ideal situation where we don’t necessarily have to go to the operating room where we can treat them with some immobilization and then some early motion.

Host:   That’s really cool. I'm sure the kids and their parents appreciate those kinds of treatments that are available. So when does it become surgical? What are some specific and technical specialized surgeries that you perform at St. Louis Children’s Hospital?

Dr. Wall:   Yeah. For a lot of our finger fractures and our wrist fractures, sometimes the overall alignment, the bone is just out of place too much. That while we know it will heal, often times it’s just not in the right spot. While sometimes some of the alignment can be realigned in an emergency room, sometimes we don’t get kids in at the emergency room. They're being avoided a little bit more with our current pandemic. Then even sometimes when we get the bone aligned in the emergency room, it displaces again. So that’s a good reason to follow up with an orthopedic surgeon to make sure that we maintain alignment. If we don’t, we have really good ways to take care of it. So what we usually do is in the operating room when the children are comfortable, they're asleep, they're not having pain we can realign the bone. We use an interoperative x-ray machine. For most of the time we can use little wires or nails that can go and hold the bones in place while they're healing and then we can remove them later. Sometimes we have to do a little bit more. We use plates and screws if we need to to hold and fix the bone sort of inside. It kind of depends on the fracture or the injury type. All of those if we get things lined up, kids usually do pretty well. Like you said, you’d mentioned before we like to engage therapy to get motion back afterwards.

I think St. Louis Children’s Hospital is really good. I think we have a really good team to help kids go through this process. Seeing me in the office, I meet them. Then we go to the operating room. We meet the nurses in the preoperative area. They're very good at helping kids kind of work through—A lot of kids have anxiety with that, which is absolutely normal and natural. They're really good at helping them to be comfortable, talking them through the anesthesia part of it, and then going back to the operating room and getting the anesthesia and going through the surgery and waking up. It’s such a supportive environment for the family and kids that it’s usually very rewarding and kids do really well. So it’s a good team.

Host:  So thank you for telling us about your team. Before we wrap up, what’s the best way—Give us some prevention advice, Dr. Wall, to protect our kid’s hands and wrists while they're playing sports. Are we wearing braces? You think of helmets for concussion and shoulder pads and throwing limits for shoulders, but we don’t always think of things to protect our children’s hands and wrists. Tell us what's going on.  

Dr. Wall: Yeah, absolutely. I think you're right. I think prevention is absolutely the way to think about injuries. I think one thing you can't put braces on all the fingers. We can't keep it from happening all the time. I think part of it is making children aware of what they're doing, being prepared for sports, being strong enough and trying to work on coordination. So practice is always important. I don’t brace kids—Wrist braces for playing soccer to try to prevent things. Just being aware. Things like playing on wet fields. I think right now what I'm seeing is very popular is seeing the wet hose on a trampoline. So that makes an incredibly slick, higher risk of injury. Not having the nets on a trampoline, things like that. Jumping out of swings or jumping off trampolines or off the monkey bars. Kids are going to be kids. They're going to want to have fun but trying to do some of the smarter moves when they're playing can be a good thing.   

Host:   It certainly can be. Do you have some best advice, final thoughts that you’d like to leave parents with about kids and hand injuries?

Dr. Wall:   Yeah, I see a lot of families who feel guilty when they come in. They think that the finger is just a sprain or just a wrist sprain. I’d say that’s very common. As a parent, you feel guilt, but I think if you have any worries if the fingers are staying swollen longer or kids are really tender, come in and be evaluated. It’s always good peace of mind to make sure you're fully evaluated and make sure that there isn’t a missed fracture that a couple of months down the line were getting evaluated. Always harder to take care of later. We are available. We typically see kids within 24 hours/48 hours of calling. So we are available to help kind of work through things, do an x-ray, and do a full evaluation. So I think getting it checked out, make sure you have peace of mind is always a good approach.

Host:   Thank you so much Dr. Wall. What a great segment. Such great usable information for parents. Thank you, again, for joining us. That concludes another episode of Mom Docs with St. Louis Children’s Hospital. You can check out the orthopedics page at stlouischildrens.org and look up conditions, treatments, and orthopedics. For more advice like this, you can check out the Mom Docs website at childrensmd.org for more information. Please remember to subscribe, rate, and review this podcast and all the other St. Louis Children’s Hospital Mom Docs podcasts. For more health tips, follow us on your social channels. I'm Melanie Cole.