Ver el código de «Fractures and dislocations (peds)»

==Clavicle &amp; Shoulder==

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| [[Clavicle fracture (peds)|Clavicle fracture]]
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treatment: Sling/swathe x3 weeks, no sports x3 weeks 

Consult ortho immediately for neurovascular compromise<br>

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| [[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==
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| [[Proximal humerus fracture]]
| 
Generally can tolerate &gt;50° angulation 

'''Classification''' - using the Neer classification system to divide humerus into 4 parts:<br>

*greater tuberosity 
*lesser tuberosity 
*anatomic neck 
*surgical neck

treatment: Sling and swathe for several weeks, ortho outpatient follow up in 3-5 days if

'''<br>'''

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| Shaft fracture
| 
Consider abuse of &lt;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 &gt;20° or adolescent &gt;10° angulation and/or radial nerve injury
|}

==Elbow==

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| [[Supracondylar fracture]]
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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>

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| Lateral condylar
| Displace &gt;2 mm, requires ortho reduction<br>
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| Medial epicondylar
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Displaced: requires open reduction by ortho 

Nondisplaced: posterior splint with forearm pronated<br>

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| Radial head and neck
| 
treatment: splint elbow 90° forearm pronated/neutrol, always follow up with ortho 

Immediate ortho consult for angulation &gt;15°<br>

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| [[Elbow dislocation]]
| High risk of neurovascular injury, always consult ortho for reduction<br>
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| 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>

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==Forearm/Wrist==

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| Radius/ulna shaft
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75% are distal third, isolated ulna very rare 

treatment: &lt;10° sugar-tong splint, immediately consult ortho for &gt;10° angulation<br>

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| [[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!

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| 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 &gt;10-15°

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| Carpal bones
| 
Fractures are rare 

If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks

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==Hand/Fingers==

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| [[Metacarpal fracture]]
| 
treatment: Distal 5th (boxer's) if nondisplaced apply gutter splint with MCP joint at 70° 

Immediate ortho consult if &gt;30-40° angulation; closed reduction often needed

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| [[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

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| [[Phalangeal finger fracture]]
| 
Distal tuft crush injury -&nbsp;treatment: laceration closure 

Most other fractures - treatment: buddy tape

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==Hip/Femur==

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| [[Hip dislocation]]
| Closed reduction within 6 hours
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| [[SCFE]] 
| 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, patient complains of hip/knee pain
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| [[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==

{| class="wikitable" 
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| [[Knee dislocation]] 
| Immediate reduction recommended, arteriogram post reduction
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| [[Patella fracture]]
| 
Non-dislocated: cylindrical cast x4-6 weeks 

Displaced &gt;3-4mm: ORIF

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| Patella dislocation 
| Closed reduction with knee immobilizer x4 weeks
|}

==Tib/Fib==

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

treatment: Posterior splint

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==Ankle & Foot==

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| Distal tibia/fibula fractures 
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Non-displaced: bulky posterior splint and crutches with ortho follow up in 3-5 days 

Tilaux: Salter III of distal tibia, requires ORIF

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| 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

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

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