View source for Fractures and dislocations (peds)

==Clavicle & Shoulder==
*[[Clavicle fracture (peds)|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<br>
**If posterior dislocation or neurovascular compromise, consult ortho immediately<br>

==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<br>
**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<br>
**treatment: Minimally displaced: long arm posterior splint with elbow at 90° and forearm protonated/neutral<br>
**Ortho follow up in 3-5 days with immobilization for 3 weeks<br>
**Immediate ortho consult for more than minimal displacement or neurovascular compromise<br>
*Lateral condylar
**Displace >2 mm, requires ortho reduction<br>
*Medial epicondylar
**Displaced: requires open reduction by ortho 
**Nondisplaced: posterior splint with forearm pronated<br>
*Radial head and neck
**treatment: splint elbow 90° forearm pronated/neutrol, always follow up with ortho 
**Immediate ortho consult for angulation >15°<br>
*[[Elbow dislocation]]
**High risk of neurovascular injury, always consult ortho for reduction<br>
*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<br>

==Forearm/Wrist==
*Radius/ulna shaft
**75% are distal third, isolated ulna very rare 
**treatment: <10° sugar-tong splint, immediately consult ortho for >10° angulation<br>
*[[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 -&nbsp;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 (main)]]
*[[Dislocations (main)]]

==References==
<references/>
*Cincinnati Children's Hospital "The Pocket" 2010-2011 

[[Category:Pediatrics]] 
[[Category:Orthopedics]]