Fractures and dislocations (peds)

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

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Humerus

Proximal fracture	Generally can tolerate >50° angulation Classification - using the Neer classification system to divide humerus into 4 parts: greater tuberosity lesser tuberosity anatomic neck surgical neck 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 Torus: Volar/short arm Greenstick/complete: Long arm posterior or sugar-tong 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