Fractures and dislocations (peds): Difference between revisions
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{| cellspacing="0" cellpadding="2" border="1" align="left" | {| cellspacing="0" cellpadding="2" border="1" align="left" | ||
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| Clavicle<br> | | Clavicle<br> | ||
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Tx: Sling/swathe x3 weeks, no sports x3 weeks | Tx: Sling/swathe x3 weeks, no sports x3 weeks | ||
Consult ortho immediately for neurovascular compromise<br> | Consult ortho immediately for neurovascular compromise<br> | ||
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| Shoulder dislocation<br> | | Shoulder dislocation<br> | ||
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Usually anterior/inferior, always get axillary view film | 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<br> | Tx: Closed reduction, sling/swathe for several weeks w/ ortho outpatient f/u due to high risk of recurrence<br> | ||
If posterior dislocation or neurovascular compromise, consult ortho immediately<br> | If posterior dislocation or neurovascular compromise, consult ortho immediately<br> | ||
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== Humerus<br> == | == Humerus<br> == | ||
{| cellspacing="0" cellpadding="2" border="1" align="left" | {| cellspacing="0" cellpadding="2" border="1" align="left" | ||
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| Proximal fracture<br> | | Proximal fracture<br> | ||
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Generally can tolerate >50° angulation | Generally can tolerate >50° angulation | ||
Tx: Sling and swathe for several weeks, ortho outpatient f/u in 3-5 days<br> | Tx: Sling and swathe for several weeks, ortho outpatient f/u in 3-5 days<br> | ||
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| Shaft fracture<br> | | Shaft fracture<br> | ||
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Consider abuse of <3 years old | Consider abuse of <3 years old | ||
Radial nerve palsy is common, resolved with treatment<br> | Radial nerve palsy is common, resolved with treatment<br> | ||
Tx: Older kids/adolescents - Hanging long arm cast, ortho outpatient f/u in 3-5 days<br> | Tx: Older kids/adolescents - Hanging long arm cast, ortho outpatient f/u in 3-5 days<br> | ||
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<br> == | == Elbow<br> == | ||
{| cellspacing="0" cellpadding="2" border="1" align="left" | {| cellspacing="0" cellpadding="2" border="1" align="left" | ||
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| Supracondylar fracture<br> | | Supracondylar fracture<br> | ||
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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) | ||
Radial/median/ulnar palsies generally resolve with reduction<br> | Radial/median/ulnar palsies generally resolve with reduction<br> | ||
Tx: Minimally displaced: long arm posterior splint with elbow at 90° and forearm protonated/neutral<br> | Tx: Minimally displaced: long arm posterior splint with elbow at 90° and forearm protonated/neutral<br> | ||
Ortho f/u in 3-5 days with immobilization for 3 weeks<br> | Ortho f/u in 3-5 days with immobilization for 3 weeks<br> | ||
Immediate ortho consult for more than minimal displacement or neurovascular compromise<br> | Immediate ortho consult for more than minimal displacement or neurovascular compromise<br> | ||
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| Lateral condylar<br> | | Lateral condylar<br> | ||
| Displace >2 mm, requires ortho reduction<br> | | Displace >2 mm, requires ortho reduction<br> | ||
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| Medial epicondylar<br> | | Medial epicondylar<br> | ||
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Displaced: requires open reduction by ortho | Displaced: requires open reduction by ortho | ||
Nondisplaced: posterior splint with forearm pronated<br> | Nondisplaced: posterior splint with forearm pronated<br> | ||
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| Radial head and neck<br> | | Radial head and neck<br> | ||
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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 | ||
Immediate ortho consult for angulation >15°<br> | Immediate ortho consult for angulation >15°<br> | ||
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| Elbow dislocation<br> | | Elbow dislocation<br> | ||
| 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<br> | | Radial head subluxation<br> | ||
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AKA 'nursemaid's elbow' | AKA 'nursemaid's elbow' | ||
Child holds are pronated, slightly flexed<br> | Child holds are pronated, slightly flexed<br> | ||
Tx: reduce with supination and flexion, post reduction patient uses arm in 5-10 minutes<br> | Tx: reduce with supination and flexion, post reduction patient uses arm in 5-10 minutes<br> | ||
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== Forearm/Wrist<br> == | == Forearm/Wrist<br> == | ||
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| Monteggia fracture<br> | | Monteggia fracture<br> | ||
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Ulna fracture and radial head dislocation | Ulna fracture and radial head dislocation | ||
Always consult ortho immediately!<br> | Always consult ortho immediately!<br> | ||
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| Galeazzi fracture<br> | | Galeazzi fracture<br> | ||
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Radial shart disruption of distal radioulnar joint | Radial shart disruption of distal radioulnar joint | ||
Always consult ortho immediately!<br> | Always consult ortho immediately!<br> | ||
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| Distal radius/ulna<br> | | Distal radius/ulna<br> | ||
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Distal radius AKA Colles' fracture | Distal radius AKA Colles' fracture | ||
Tx: Splint and ortho f/u in 3-5 days<br> | Tx: Splint and ortho f/u in 3-5 days<br> | ||
*Torus: Volar/short arm<br> | *Torus: Volar/short arm<br> | ||
*Greenstick/complete: Long are posterior or sugar-tong<br> | *Greenstick/complete: Long are posterior or sugar-tong<br> | ||
Immediate ortho consult for angluation >10-15°<br> | Immediate ortho consult for angluation >10-15°<br> | ||
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| Carpal bones<br> | | Carpal bones<br> | ||
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Fractures are rare | Fractures are rare | ||
If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks<br> | If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks<br> | ||
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== Hand/Fingers<br> == | == Hand/Fingers<br> == | ||
{| cellspacing="0" cellpadding="2" border="1" align="left" | {| cellspacing="0" cellpadding="2" border="1" align="left" | ||
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| Metacarpal fracture<br> | | Metacarpal fracture<br> | ||
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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<br> | Immediate ortho consult if >30-40° angulation; closed reduction often needed<br> | ||
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| Phalangeal dislocation<br> | | Phalangeal dislocation<br> | ||
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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 | ||
MCP - If initial reduction fails. consult hand surgeon (plastics) | MCP - If initial reduction fails. consult hand surgeon (plastics) | ||
Refer gamekeeper's thump (avulsion of ulnar collateral ligament; requires thumb spica x3-6 weeks | Refer gamekeeper's thump (avulsion of ulnar collateral ligament; requires thumb spica x3-6 weeks | ||
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| Phalangeal fracture | | Phalangeal fracture | ||
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Distal tuft crush injury - Tx: laceration closure | Distal tuft crush injury - Tx: laceration closure | ||
Most other fractures - Tx: buddy tape | Most other fractures - Tx: buddy tape | ||
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== Hip/Femur == | == Hip/Femur == | ||
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{| cellspacing="0" cellpadding="2" border="1" align="left" | {| cellspacing="0" cellpadding="2" border="1" align="left" | ||
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| Hip dislocation | | Hip dislocation | ||
| Closed reduction within 6 hours | | Closed reduction within 6 hours | ||
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| SCFE | | SCFE | ||
| 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, pt complains of hip/knee pain | | 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, pt complains of hip/knee pain | ||
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| Femoral shaft fractures | | Femoral shaft fractures | ||
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Birth-2yo: Traction or immediate casting | Birth-2yo: Traction or immediate casting | ||
2-10yo: Ortho consult, traction with spica casting | 2-10yo: Ortho consult, traction with spica casting | ||
Adolescent: Stabilize with traction splint, consult ortho | Adolescent: Stabilize with traction splint, consult ortho | ||
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| Femoral neck fractures | | Femoral neck fractures | ||
| 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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{| cellspacing="0" cellpadding="2" border="1" align="left" | {| cellspacing="0" cellpadding="2" border="1" align="left" | ||
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| Knee dislocation | | Knee dislocation | ||
| Immediate reduction recommended, arteriogram post reduction | | Immediate reduction recommended, arteriogram post reduction | ||
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| Patella fracture | | Patella fracture | ||
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Non-dislocated: cylindrical cast x4-6 weeks | Non-dislocated: cylindrical cast x4-6 weeks | ||
Displaced >3-4mm: ORIF | Displaced >3-4mm: ORIF | ||
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| Patella dislocation | | Patella dislocation | ||
| Closed reduction with knee immobilizer x4 weeks | | Closed reduction with knee immobilizer x4 weeks | ||
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== Tib/Fib == | |||
== Tib/Fib == | |||
{| cellspacing="0" cellpadding="2" border="1" align="left" | {| cellspacing="0" cellpadding="2" border="1" align="left" | ||
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| Proximal tibia | | Proximal tibia | ||
| Early ortho consult especially if intra-articular | | Early ortho consult especially if intra-articular | ||
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| Tib/fib shaft | | Tib/fib shaft | ||
| Long leg posterior splint, ortho f/u in 3-5 days | | Long leg posterior splint, ortho f/u in 3-5 days | ||
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| Toddler's | | Toddler's | ||
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Technically an oblique non displaced fracture of the distal tibia | Technically an oblique non displaced fracture of the distal tibia | ||
Tx: Posterior splint | Tx: Posterior splint | ||
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== Ankle & Foot == | == Ankle & Foot == | ||
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== Source == | == Source == |
Revision as of 19:59, 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
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 |
Source
Cincinnati Children's Hospital "The Pocket" 2010-2011