Fractures and dislocations (peds)
Fractures and Dislocations (Peds)
| Clavicle |
Tx: Sling/swathe x3 weeks, no sports x3 weeks Consult ortho immediately for neurovascular compromise |
| Shoulder dislocation |
Usually anterior/inferior, always get axillary view film Tx: Closed reduction, sling/swathe for several weeks w/ ortho outpatient f/u due to high risk of recurrence If posterior dislocation or neurovascular compromise, consult ortho immediately |
Humerus
| Proximal fracture |
Generally can tolerate >50° angulation Tx: Sling and swathe for several weeks, ortho outpatient f/u in 3-5 days |
| Shaft fracture |
Consider abuse of <3 years old Radial nerve palsy is common, resolved with treatment Tx: Older kids/adolescents - Hanging long arm cast, ortho outpatient f/u in 3-5 days Immediate ortho consult: Child >20° or adolescent >10° angulation and/or radial nerve injury |
Elbow
| Supracondylar fracture |
On XR - posterior and anterior fat pads, anterior humeral line (bisects mid 1/3 of capitellum) Radial/median/ulnar palsies generally resolve with reduction Tx: Minimally displaced: long arm posterior splint with elbow at 90° and forearm protonated/neutral Ortho f/u in 3-5 days with immobilization for 3 weeks Immediate ortho consult for more than minimal displacement or neurovascular compromise |
| Lateral condylar |
Displace >2 mm, requires ortho reduction |
| Medial epicondylar |
Displaced: requires open reduction by ortho Nondisplaced: posterior splint with forearm pronated |
| Radial head and neck |
Tx: splint elbow 90° forearm pronated/neutrol, always f/u with ortho Immediate ortho consult for angulation >15° |
| Elbow dislocation |
High risk of neurovascular injury, always consult ortho for reduction |
| Radial head subluxation |
AKA 'nursemaid's elbow' Child holds are pronated, slightly flexed Tx: reduce with supination and flexion, post reduction patient uses arm in 5-10 minutes |
Forearm/Wrist
| Radius/ulna shaft |
75% are distal third, isolated ulna very rare Tx: <10° sugar-tong splint, immediately consult ortho for >10° angulation |
Source
Cincinnati Children's Hospital "The Pocket" 2010-2011