Fractures and dislocations (peds)

Clavicle & Shoulder

  • Clavicle fracture
    • Treatment: Sling/swathe x3 weeks, no sports x3 weeks
    • Consult ortho immediately for neurovascular compromise
  • Shoulder dislocation
    • Usually anterior/inferior, always get axillary view film
    • Treatment: Closed reduction, sling/swathe for several weeks with ortho outpatient follow up due to high risk of recurrence
    • If posterior dislocation or neurovascular compromise, consult ortho immediately


  • Proximal humerus 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
    • treatment: Sling and swathe for several weeks, ortho outpatient follow up in 3-5 days if
  • Shaft fracture
    • Consider abuse of <3 years old
    • Radial nerve palsy is common, resolved with treatment
    • treatment: Older kids/adolescents - Hanging long arm cast, ortho outpatient follow up in 3-5 days
    • Immediate ortho consult: Child >20° or adolescent >10° angulation and/or radial nerve injury


  • 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
    • treatment: Minimally displaced: long arm posterior splint with elbow at 90° and forearm protonated/neutral
    • Ortho follow up 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
    • treatment: splint elbow 90° forearm pronated/neutrol, always follow up 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
    • treatment: reduce with supination and flexion, post reduction patient uses arm in 5-10 minutes


  • Radius/ulna shaft
    • 75% are distal third, isolated ulna very rare
    • treatment: <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
    • treatment: Splint and ortho follow up 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


  • Metacarpal fracture
    • treatment: 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 finger 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 finger fracture
    • Distal tuft crush injury - treatment: laceration closure
    • Most other fractures - treatment: buddy tape


  • Hip dislocation
    • Closed reduction within 6 hours
  • SCFE
    • 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, patient 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


Closed reduction with knee immobilizer x4 weeks


  • Proximal tibia fracture
    • Early ortho consult especially if intra-articular
  • Tib/fib shaft
    • Long leg posterior splint, ortho follow up in 3-5 days
  • Toddler's fracture
    • Technically an oblique non displaced fracture of the distal tibia
    • treatment: Posterior splint

Ankle & Foot

  • Distal tibia/fibula fractures
    • Non-displaced: bulky posterior splint and crutches with ortho follow up 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
    • treatment: bulky posterior splint, crutches, ortho follow up 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


  • Cincinnati Children's Hospital "The Pocket" 2010-2011