Good Enough: When to Avoid Perfection and Accept Adequate Surgery Results in Pediatric Hand Surgery.

J Hand Surg Am · Nov 2026 · Review

Davit AJ, Krakauer KN, Berger AJ, Galvez MG

Division of Plastic and Hand Surgery, Valley Children's Hospital, Madera, CA

Hand & Upper Extremity Pediatric Orthopaedics

SUMMARY — THE REDUCTIONThis article argues that in pediatric hand surgery, accepting adequate reconstruction is often better than pursuing a perfect radiograph, since overly aggressive surgery risks lost reduction, poor healing, vascular compromise, growth plate failure, and contractures.
Abstract, as published

Pediatric hand surgery frequently requires precise surgical reconstruction of the upper limb to prevent worsening deformity. However, there is a balance of achieving a perfect radiologic film of the planned surgery and causing inadvertent harm from performing overly aggressive surgery. Precise K-wire placement and immobilization are important for optimal results; however, surgery that is too invasive results in several downsides, including loss of reduction, poor bony healing, loss of blood supply, growth plate failure, and scar contractures from poor wound healing. Here, we review this important concept of "Good Enough" to accept completely adequate results over unattainable perfection in pediatric hand surgery.

Featured in the 2026-10-28 issue.

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