The use of corporal punishment in educational settings has become increasingly rare during recent decades and is forbidden in the school systems of nearly all advanced industrial nations. This custom, however, persists in some places in the modern world, principally in 23 states of the United States, parts of Canada and parts of Australia. In these places, the right of persons in charge of pupils to inflict corporal punishment (physical battering) is defended by a small minority of educators, school administrators and members of government.

One such method of corporal punishment is to strike children on the hand, using a variety of implements such as a wood or metal ruler, a leather strap called a 'tawse' or a stick called a 'cane.' In this statement, the undersigned address the potential physical risks incurred by children when their hands are struck in this manner.

There exists a whole range of orthopedic complications which can result from striking the hand of a child with a cane, ruler, strap or other such implement. The hand is particularly sensitive to injury because of the proximity of the ligaments, tendons, nerves and blood vessels to the skin, which does not have underlying protective tissue. Younger children are even more susceptible to permanent deformity because of the possibility of injury to growth plates in the bones. Injuries can range from fractures to dislocation, particularly to the terminal phalangeal joint, which could possibly lead to premature osteoarthritic changes. There are also risks of developing severe infections in the fascial spaces of the hand, particularly if there are pre-existing undiagnosed subungual infections. Infections of the hand often require hospitalization, and create a significant risk of loss of function of the hand.

Zeno Chicarilli, M.D.
American Society for Surgery of Hands; American Society of Plastic and Reconstructive Surgeons; Clinical Assistant Professor of Surgery, Yale University, Connecticut

Bernard J. Cullen, M.D.
Fellow of the American Academy of Pediatrics; Associate Professor of Pediatrics and Director of the Child Abuse Prevention Program at the Medical College of Ohio.

Norman M. Harris, M.D.
Fellow of the American College of Surgeons (FACS); Fellow of the American Academy of Orthopedic Surgeons (AAOS), Piedmont, California

Alexander Kalenak, M.D.
Professor of Orthopedic Surgery; Director of the Sports Medicine Program at the College of Medicine, Pennsylvania State University, Hershey, Pennsylvania

James R. Lewis, M.D.
Fellow of the American College of Surgeons (FACS); Fellow of the American Academy of Orthopedic Surgeons (AAOS); San Juan, Puerto Rico

Richard E. McCarthy, M.D.
Fellow of the American College of Surgeons (FACS); Fellow of the American Academy of the Orthopedic Surgeons (AAOS); Clinical Associate Professor of Orthopedics and Pediatrics at the University of Arkansas for Medical Sciences, Arkansas Children's Hospital

Barry McKinley, M.D.
Orthopedic surgeon, Berkeley Orthopedic Medical Group, Berkeley, California

R. K. Oates, M.B., B.S.
Professor of Pediatrics and Child Health, University of Sydney, Chairman of the Division of Medicine at the Royal Alexandra Hospital for Children, Camperdown, New South Wales, Australia

Robert Poss, M.D.
Associate Professor of Orthopedic Surgery, Harvard Medical School; orthopedic surgeon, Brigham and Women's Hospital, Boston, Massachusetts

Edwards P. Schwentker, M.D.
Associate Professor of Surgery, Division of Orthopedic Surgery, Pennsylvania State University; Medical Director of the Elizabethtown Hospital and Rehabilitation Center, Pennsylvania

Anthony Shaw, M.D.
Professor of Surgery, University of California, Los Angeles, Chief of Pediatric Surgery, Olive View Medical Center, Sylmar, California

Lesli Ann Taylor, M.D.
Pediatric Surgery, Children's Hospital of Philadelphia, Pennsylvania