Principles, and not established rules, form the basis for treating children with painful, posttraumatic arthritis involving the hand and wrist. The authors' preference is to exhaust nonoperative measures unless the involved joints are unstable or grossly incongruent. The authors would also recommend a greater degree of cautious observation in young children because of reports of successful outcomes associated with remodeling. Once surgery is necessary, the authors prefer motion-preserving procedures, bearing in mind that arthrodesis is well tolerated in the thumb interphalangeal joint and the finger DIP joints. Some authors have presented novel treatments, including complex microvascular reconstructions, but these authors recommend these procedures only in special circumstances, and only by physicians who are experienced with the techniques.