- [Home](https://ortopediaevolutiva.com/en) - [Pediatric Orthopaedics Blog — Dr. Priano](https://ortopediaevolutiva.com/en/blog) - Skier’s thumb in children: sprain or fracture? # Skier’s thumb in children: sprain or fracture? November 13, 2026 3 min read Edited and medically reviewed by [Dr. Daniele Priano](https://ortopediaevolutiva.com/en/about) ![Skier’s thumb in children: sprain or fracture?](https://qoxwtbnwsrbatawnkgst.supabase.co/storage/v1/object/public/blog-images/editorial/41605920-ca35-8146-b76c-ffe431b59f5b/af0ea6d482591682c34897400a2cab5e1fc623ac29d87fa3f3017366a1e8360b.png) This English version is based on the original Italian article. For wording nuances, you can refer to the Italian version. ## In short, for parents - • Thumb pain after a skiing fall: ligament injury, possible fracture, X-ray limitations and the factors guiding treatment in children. Pain at the base of the thumb after a skiing fall may come from the ligament, a [fracture](https://ortopediaevolutiva.com/en/conditions/injuries-fractures), or both. Swelling and difficulty gripping need assessment. [AAOS](https://www.orthoinfo.org/bodypart/hand-wrist/sprained-thumb/) ### What is injured in skier’s thumb? The ulnar collateral ligament lies at the base of the thumb, on the side facing the index finger. It helps keep the thumb stable during gripping. A fall that forces the thumb away from the hand can stretch or tear it; a ski pole may contribute to this movement. Sometimes the ligament pulls away a small piece of bone: an avulsion fracture. In children, possible growth plate involvement must also be considered. These are different findings and need to be distinguished during diagnosis. [RCH](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Thumb_Fractures_-_Emergency_Department/) ### Is a normal X-ray enough? An X-ray looks for a fracture and assesses its position. It does not directly show whether the ligament is intact: the image may look normal despite a significant ligament injury. Examination assesses pain and stability. Do not try bending the thumb sideways at home. A specialist may request ultrasound or MRI when uncertainty remains; these tests are not always needed. [AAOS](https://www.orthoinfo.org/bodypart/hand-wrist/sprained-thumb/) ### Cast, splint or surgery Partial, stable injuries can be protected with a cast or splint that also immobilises the thumb. The choice and follow-up depend on the injury. Marked instability, a complete tear or a displaced bone fragment requires specialist assessment of whether surgery is indicated. One particular problem is a Stener lesion: tissue lies between the torn ligament and its attachment, preventing it from healing back in the correct position. [BSSH](https://www.bssh.ac.uk/patients/conditions/32/skiers_thumb) In children, however, a displaced fragment does not automatically mean an operation is needed. A retrospective study of paediatric avulsion fractures reported healing with immobilisation alone in some cases that met conventional surgical criteria. It was not a randomised trial and does not establish that immobilisation and surgery are interchangeable. Examination, imaging and follow-up all inform the decision. [Huynh and colleagues](https://pubmed.ncbi.nlm.nih.gov/30857433/) ### When to seek care and return to sport Pain, swelling and difficulty using the thumb after an injury need prompt assessment. An obvious deformity, a blue or numb digit, or a wound with visible bone needs urgent assessment in an emergency department. While waiting, avoid loading the hand or trying to straighten the digit. [NHS](https://www.nhs.uk/conditions/broken-finger/) Returning to skiing depends on the injury, treatment and recovery of stability and function. Less pain or wearing a splint does not establish readiness for another fall: return to sport should be agreed with the treating clinician. [Lurie Children’s](https://www.luriechildrens.org/en/specialties-conditions/skiers-or-gamekeepers-thumb/) For the broader context, see [injuries and fractures in children](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) and [growth plate fractures](https://ortopediaevolutiva.com/en/surgery/physeal-fractures). *Dr Daniele Priano — Paediatric Orthopaedics. General information: this does not replace an individual medical assessment.* ### References - Royal Children’s Hospital Melbourne. [Thumb Fractures – Emergency Department](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Thumb_Fractures_-_Emergency_Department/). - Ann & Robert H. Lurie Children’s Hospital of Chicago. [Skier’s or Gamekeeper’s Thumb](https://www.luriechildrens.org/en/specialties-conditions/skiers-or-gamekeepers-thumb/). - American Academy of Orthopaedic Surgeons (AAOS), OrthoInfo. [Sprained Thumb](https://www.orthoinfo.org/bodypart/hand-wrist/sprained-thumb/). - British Society for Surgery of the Hand. [Skier’s thumb](https://www.bssh.ac.uk/patients/conditions/32/skiers_thumb). - Huynh MNQ, Tang K, Cheung K. A Comparison of Conservative and Operative Management of Thumb Ulnar Collateral Ligament Avulsion Fractures in Children. Hand (N Y). 2020;15(6):812–817. [DOI: 10.1177/1558944719831237](https://doi.org/10.1177/1558944719831237). [PMID: 30857433](https://pubmed.ncbi.nlm.nih.gov/30857433/). - NHS. [Broken finger or thumb](https://www.nhs.uk/conditions/broken-finger/). Online sources accessed on 12 November 2026. ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-CTvqnoPa.webp) ### Concerned about your child? If you recognize any of these signs in your child, a specialist assessment can give you clarity. I see children at Gaetano Pini and CTO institutes in Milan. 5.0 · Google & MioDottore [Book a private visit](https://ortopediaevolutiva.com/en/locations#prenota) ### Related Conditions [Fractures and trauma](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) ### Related Surgery Pages [Fracture treatment](https://ortopediaevolutiva.com/en/surgery/injuries-fractures) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-BiLSxBxW.webp) Author and medical reviewer ## Dr. Daniele Priano [Pediatric orthopaedic care in Milan](https://ortopediaevolutiva.com/en) — Gaetano Pini & CTO [Read full bio](https://ortopediaevolutiva.com/en/about) --- Canonical: https://ortopediaevolutiva.com/en/blog/skiers-thumb-children-sprain-fracture Le informazioni cliniche sono divulgative e non sostituiscono una valutazione medica diretta.