Team Approach: The Care of Children with Hand and Upper Limb Differences.

¼ Pediatric hand and upper limb differences include a wide range of conditions that may be genetic, part of a syndrome, or arise from birth trauma or an unknown cause.¼ Because of the variety of conditions and complexity of care requiring professionals from multiple disciplines, the Pediatric Hand Team is similar in purpose to the coordinated multidisciplinary care provided by Craniofacial Panels for children with craniofacial anomalies. Pediatric hand surgeons are trained to lead and coordinate the care of children with these differences, and the Pediatric Hand Team includes occupational and/or certified hand therapists, child life specialists, geneticists and genetic counselors, prosthetists and orthotists, pediatric physical medicine and rehabilitation physicians, pediatric orthopaedic surgeons, pediatric anesthesiologists, and social workers and psychologists. The Team must also have access to pediatric imaging, including ultrasound and magnetic resonance imaging.¼ Treatment of hand differences may include observation, splinting/bracing, therapy, reconstructive surgery, or a combination of these, and indications vary with development, age, associated conditions, and child and family preference. Children who have challenges coping with the stigma of their difference may benefit from programs such as Hand Camp and the Lucky Fin Project.¼ Multiple online and print resources are available to support the Pediatric Hand Team and the child's family and other caregivers.¼ A well-coordinated team-based approach meets the physical and psychosocial needs of the child with hand and upper limb differences from birth to adulthood.

Allyship for Diversity, Equity, and Inclusion in Hand Surgery.

This article endeavors to be a resource to those individuals interested in becoming an ally or educating potential allies in the field of Hand Surgery. The definitions of allyship, its history, and its expected benefits are considered. The qualities of a good ally are enumerated, and approaches to becoming a better ally are described. The authors provide personal experience with impactful allies and describe strategies and resources on a local and national level. The authors conclude with "Bigger Questions": those issues that seem essential to have allyship succeed in expanding diversity, equity, and inclusion in the specialty.

Trigger Thumb in Pediatric Patients: A 20-Year Update.

BACKGROUND: The study purpose was to analyze the characteristics of patients presenting for evaluation of pediatric trigger thumb over a 20-year period and to determine what factors were associated with operative versus nonoperative management. METHODS: All patients evaluated for a pediatric trigger thumb by 1 of 2 hand surgeons at our institution between January 1, 2000, and August 31, 2021, were retrospectively reviewed. Data were collected, including patient demographics, laterality, patient age and stage of triggering at presentation, treatment recommendations, age at surgery (if performed), and complications. Comparison was made based on age group (<2 years, 2-5 years, and >5 years). Subgroup analysis was performed for patients who had alternative treatments recommended prior to surgery. RESULTS: A total of 381 patients (468 thumbs) were identified. The average age at presentation was 3.1 years, 76% were stage IV locked trigger thumbs, and 78% underwent surgery. Patients below 2 years were more likely to have bilateral involvement and have nonoperative management recommended prior to surgery. Those below 5 years were more likely to present with stage IV triggering. Patients who presented with a stage IV trigger thumb and had an initial alternative treatment were more likely to go on to have surgery. The total complication rate was 5.3%. CONCLUSIONS: These findings are helpful in counseling families and better understanding this patient population. We recommend early surgical intervention, rather than observation or splinting, for patients with stage IV trigger thumbs who can safely undergo anesthesia.