Fractures and dislocations (peds): Difference between revisions
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| Proximal fracture | | [[Proximal humerus fracture]] | ||
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Generally can tolerate >50° angulation | Generally can tolerate >50° angulation | ||
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*surgical neck | *surgical neck | ||
Tx: Sling and swathe for several weeks, ortho outpatient f/u in 3-5 days if | Tx: Sling and swathe for several weeks, ortho outpatient f/u in 3-5 days if | ||
'''<br>''' | '''<br>''' | ||
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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 | 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 | Immediate ortho consult: Child >20° or adolescent >10° angulation and/or radial nerve injury | ||
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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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| 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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AKA 'nursemaid's elbow' | AKA 'nursemaid's elbow' | ||
Child holds are pronated, slightly flexed | Child holds are pronated, slightly flexed | ||
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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| Monteggia fracture | | [[Monteggia fracture]] | ||
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Ulna fracture and radial head dislocation | Ulna fracture and radial head dislocation | ||
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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 | ||
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| Distal radius/ulna | | Distal radius/ulna | ||
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Distal radius AKA Colles' fracture | Distal radius AKA Colles' fracture | ||
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Tx: Splint and ortho f/u in 3-5 days | Tx: Splint and ortho f/u in 3-5 days | ||
*Torus: Volar/short arm | *Torus: Volar/short arm | ||
*Greenstick/complete: Long arm posterior or sugar-tong | *Greenstick/complete: Long arm posterior or sugar-tong | ||
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| Carpal bones | | Carpal bones | ||
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Fractures are rare | Fractures are rare | ||
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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° | ||
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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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| Phalangeal fracture | | [[Phalangeal fracture]] | ||
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Distal tuft crush injury - Tx: laceration closure | Distal tuft crush injury - Tx: laceration closure | ||
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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 | | [[Femoral shaft fracture]] | ||
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Birth-2yo: Traction or immediate casting | Birth-2yo: Traction or immediate casting | ||
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| Femoral neck | | [[Femoral neck fracture]] | ||
| 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 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 | ||
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| Proximal tibia | | [[Proximal tibia fracture]] | ||
| Early ortho consult especially if intra-articular | | Early ortho consult especially if intra-articular | ||
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| 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 fracture]] | ||
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Technically an oblique non displaced fracture of the distal tibia | Technically an oblique non displaced fracture of the distal tibia | ||
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== Ankle & | == Ankle & Foot == | ||
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Revision as of 20:33, 8 June 2015
Clavicle & Shoulder
| Clavicle fracture |
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 humerus 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
|
| 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 fracture |
Birth-2yo: Traction or immediate casting 2-10yo: Ortho consult, traction with spica casting Adolescent: Stabilize with traction splint, consult ortho |
| Femoral neck fracture | 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 fracture | Early ortho consult especially if intra-articular |
| Tib/fib shaft | Long leg posterior splint, ortho f/u in 3-5 days |
| Toddler's fracture |
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