Fractures and dislocations (peds): Difference between revisions
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== Forearm/Wrist<br> == | == Forearm/Wrist<br> == | ||
{| cellspacing="0" cellpadding="2" border="1" align="left" | {| cellspacing="0" cellpadding="2" border="1" align="left" | ||
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| Radius/ulna shaft<br> | | Radius/ulna shaft<br> | ||
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75% are distal third, isolated ulna very rare | 75% are distal third, isolated ulna very rare | ||
Tx: <10° sugar-tong splint, immediately consult ortho for >10° angulation<br> | Tx: <10° sugar-tong splint, immediately consult ortho for >10° angulation<br> | ||
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| <br> | | Monteggia fracture<br> | ||
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Ulna fracture and radial head dislocation | |||
Always consult ortho immediately!<br> | |||
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| Galeazzi fracture<br> | |||
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Radial shart disruption of distal radioulnar joint | |||
Always consult ortho immediately!<br> | |||
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| Distal radius/ulna<br> | |||
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Distal radius AKA Colles' fracture | |||
Tx: Splint and ortho f/u in 3-5 days<br> | |||
*Torus: Volar/short arm<br> | |||
*Greenstick/complete: Long are posterior or sugar-tong<br> | |||
Immediate ortho consult for angluation >10-15°<br> | |||
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| Carpal bones<br> | |||
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Fractures are rare | |||
If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks<br> | |||
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== Hand/Fingers<br> == | |||
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| <br> | | Metacarpal fracture<br> | ||
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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<br> | |||
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| <br> | | Phalangeal dislocation<br> | ||
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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 | |||
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| | | Phalangeal fracture | ||
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Distal tuft crush injury - Tx: laceration closure | |||
Most other fractures - Tx: buddy tape | |||
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== Hip/Femur == | |||
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Revision as of 18:21, 9 July 2011
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 |
| 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
Source
Cincinnati Children's Hospital "The Pocket" 2010-2011