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

Humerus

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

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 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

Forearm/Wrist

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

Hand/Fingers

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/Femur

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

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 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

• Fractures

References

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