Fractures and dislocations (peds): Difference between revisions
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| Shaft fracture | | Shaft fracture | ||
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Consider abuse of <3 years old | Consider abuse of <3 years old | ||
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Immediate ortho consult: Child >20° or adolescent >10° angulation and/or radial nerve injury<br> | Immediate ortho consult: Child >20° or adolescent >10° angulation and/or radial nerve injury<br> | ||
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== Elbow == | == Elbow == | ||
{| | {| class="wikitable" | ||
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| Supracondylar fracture | | Supracondylar fracture | ||
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On XR - posterior and anterior fat pads, anterior humeral line (bisects mid 1/3 of capitellum) | On XR - posterior and anterior fat pads, anterior humeral line (bisects mid 1/3 of capitellum) | ||
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| Lateral condylar | | Lateral condylar | ||
| Displace >2 mm, requires ortho reduction<br> | | Displace >2 mm, requires ortho reduction<br> | ||
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| Medial epicondylar | | Medial epicondylar | ||
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Displaced: requires open reduction by ortho | Displaced: requires open reduction by ortho | ||
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| Radial head and neck | | Radial head and neck | ||
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Tx: splint elbow 90° forearm pronated/neutrol, always f/u with ortho | Tx: splint elbow 90° forearm pronated/neutrol, always f/u with ortho | ||
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| Elbow dislocation | | Elbow dislocation | ||
| High risk of neurovascular injury, always consult ortho for reduction<br> | | High risk of neurovascular injury, always consult ortho for reduction<br> | ||
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| Radial head subluxation | | Radial head subluxation | ||
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AKA 'nursemaid's elbow' | AKA 'nursemaid's elbow' | ||
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== Forearm/Wrist== | |||
{| class="wikitable" | |||
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| Radius/ulna shaft | | Radius/ulna shaft | ||
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75% are distal third, isolated ulna very rare | 75% are distal third, isolated ulna very rare | ||
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| Monteggia fracture | | Monteggia fracture | ||
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Ulna fracture and radial head dislocation | Ulna fracture and radial head dislocation | ||
Always consult ortho immediately! | Always consult ortho immediately! | ||
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| Galeazzi fracture | | Galeazzi fracture | ||
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Radial shart disruption of distal radioulnar joint | Radial shart disruption of distal radioulnar joint | ||
Always consult ortho immediately! | Always consult ortho immediately! | ||
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Distal radius AKA Colles' fracture | Distal radius AKA Colles' fracture | ||
Tx: Splint and ortho f/u in 3-5 days | Tx: Splint and ortho f/u in 3-5 days | ||
*Torus: Volar/short arm<br> | *Torus: Volar/short arm<br> | ||
*Greenstick/complete: Long arm posterior or sugar-tong | *Greenstick/complete: Long arm posterior or sugar-tong | ||
Immediate ortho consult for angluation >10-15° | Immediate ortho consult for angluation >10-15° | ||
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Fractures are rare | Fractures are rare | ||
If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks | If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks | ||
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== Hand/Fingers== | |||
{| class="wikitable" | |||
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| Metacarpal fracture | | Metacarpal fracture | ||
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Tx: Distal 5th (boxer's) if nondisplaced apply gutter splint with MCP joint at 70° | Tx: Distal 5th (boxer's) if nondisplaced apply gutter splint with MCP joint at 70° | ||
Immediate ortho consult if >30-40° angulation; closed reduction often needed | Immediate ortho consult if >30-40° angulation; closed reduction often needed | ||
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| Phalangeal dislocation | | Phalangeal dislocation | ||
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PIP/DIP - Reduce and buddy tape x3 weeks, if PIP consider digital block pre-reduction | PIP/DIP - Reduce and buddy tape x3 weeks, if PIP consider digital block pre-reduction | ||
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== Hip/Femur == | == Hip/Femur == | ||
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| Hip dislocation | | Hip dislocation | ||
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| Traction/splint with ortho consult for closed or open reduction | | Traction/splint with ortho consult for closed or open reduction | ||
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== Knee == | == Knee == | ||
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| Knee dislocation | | Knee dislocation | ||
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| Closed reduction with knee immobilizer x4 weeks | | Closed reduction with knee immobilizer x4 weeks | ||
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== Tib/Fib == | == Tib/Fib == | ||
{| | {| class="wikitable" | ||
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| Proximal tibia | | Proximal tibia | ||
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== Ankle & Foot == | == Ankle & Foot == | ||
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| Distal tibia/fibula fractures | | Distal tibia/fibula fractures | ||
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==See Also== | ==See Also== | ||
Revision as of 20:29, 8 June 2015
Clavicle & Shoulder
| 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 Classification - using the Neer classification system to divide humerus into 4 parts:
Tx: Sling and swathe for several weeks, ortho outpatient f/u in 3-5 days if
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| 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 |
| Monteggia fracture |
Ulna fracture and radial head dislocation Always consult ortho immediately! |
| Galeazzi fracture |
Radial shart disruption of distal radioulnar joint Always consult ortho immediately! |
| Distal radius/ulna |
Distal radius AKA Colles' fracture Tx: Splint and ortho f/u in 3-5 days
Immediate ortho consult for angluation >10-15° |
| Carpal bones |
Fractures are rare If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks |
Hand/Fingers
| Metacarpal fracture |
Tx: Distal 5th (boxer's) if nondisplaced apply gutter splint with MCP joint at 70° Immediate ortho consult if >30-40° angulation; closed reduction often needed |
| Phalangeal dislocation |
PIP/DIP - Reduce and buddy tape x3 weeks, if PIP consider digital block pre-reduction MCP - If initial reduction fails. consult hand surgeon (plastics) Refer gamekeeper's thump (avulsion of ulnar collateral ligament; requires thumb spica x3-6 weeks |
| Phalangeal fracture |
Distal tuft crush injury - Tx: laceration closure Most other fractures - Tx: buddy tape |
Hip/Femur
| Hip dislocation | Closed reduction within 6 hours |
| SCFE | 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, pt complains of hip/knee pain |
| Femoral shaft fractures |
Birth-2yo: Traction or immediate casting 2-10yo: Ortho consult, traction with spica casting Adolescent: Stabilize with traction splint, consult ortho |
| Femoral neck fractures | Traction/splint with ortho consult for closed or open reduction |
Knee
| Knee dislocation | Immediate reduction recommended, arteriogram post reduction |
| Patella fracture |
Non-dislocated: cylindrical cast x4-6 weeks Displaced >3-4mm: ORIF |
| Patella dislocation | Closed reduction with knee immobilizer x4 weeks |
Tib/Fib
| Proximal tibia | Early ortho consult especially if intra-articular |
| Tib/fib shaft | Long leg posterior splint, ortho f/u in 3-5 days |
| Toddler's |
Technically an oblique non displaced fracture of the distal tibia Tx: Posterior splint |
Ankle & Foot
| Distal tibia/fibula fractures |
Non-displaced: bulky posterior splint and crutches with ortho f/u in 3-5 days Tilaux: Salter III of distal tibia, requires ORIF |
| Mid/Hindfoot fractures |
Talus: pain with dorsiflexion Calcaneous: fall from a height Midfoot fractures are rare Tx: bulky posterior splint, crutches, ortho f/u in 3-5 days |
| Metatarsal/phalangeal |
Base of 5th metatarsal: 'Jones fracture', high nonunion rate Non-displaced - bulky splint and crutches Phalanged: buddy tape, hard soled shoes Intra-articular: great toe and/or significant displacement requires pinning |
See Also
Source
- Cincinnati Children's Hospital "The Pocket" 2010-2011