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Upper Extremity Fractures

Children break bones more easily than adults - so pediatric fractures are very common. There are several unique features of the pediatric musculoskeletal system that need to be considered in management decisions of all of these injuries - growth plates, plasticity, callus formation, remodeling potential, and partial breaks are some of the key ones. Recognition and appropriate management of pediatric fractures by ED providers is critical. While some common minor wrist and ankle fractures can be treated with a less conservative approach encouraging an early return to activities, other fractures if not treated properly can result in long term functional problems for the child and/or be a sign of child maltreatment.

BROWSE EVIDENCE REPOSITORY

 

Clinical guidelines

Clinical Practice Guideline: Paediatric fracture guidelines - Proximal humerus

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Victorian Paediatric Orthopaedic Network

Most proximal humeral fractures do not require reduction as remodelling is extremely effective in the proximal humerus. The usual treatment for this fracture is immobilisation of the shoulder in a sling, body swathe or shoulder immobiliser. Patients should be seen in the fracture clinic or by an interested GP within 7 days for follow-up with x-rays to assess further displacement.

Clinical Practice Guideline: Paediatric fracture guidelines - Wrist (distal radius and ulna)

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Victorian Paediatric Orthopaedic Network

Clinical practice guidelines: Wrist fractures

Clinical Practice Guideline: Paediatric fracture guidelines - Forearm

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Victorian Paediatric Orthopaedic Network

Clinical practice guidelines: Forearm fractures

Clinical Practice Guideline: Paediatric fracture guidelines - Clavicle

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Victorian Paediatric Orthopaedic Network

Summary of fracture type, ED management, and follow-up.

Clinical Practice Guideline: Paediatric fracture guidelines - Elbow

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Victorian Paediatric Orthopaedic Network

Clinical practice guidelines: Elbow fractures

Clinical Practice Guideline: Paediatric fracture guidelines - Humeral shaft (diaphysis)

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Victorian Paediatric Orthopaedic Network

Reduction is seldom required for humeral shaft fractures. Fractures will usually "hang out" (i.e. under influence of gravity) to good alignment and apposition using a collar and cuff. Mid-shaft humeral fractures should be followed up in fracture clinic at 1 week. Spiral fractures of the humerus in toddler age and younger are strongly linked with non-accidental injury. Careful history and examination are required to determine the child at risk.

Clinical Practice Guideline: Supracondylar Fractures

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Camp, M

Supracondylar fractures: ED management, outpatient/fracture clinic management, operative management

Clinical Practice Guideline: The treatment of pediatric supracondylar humerus fractures

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Howard, A, Mulpuri, K, Abel, MF, Braun, S, Bueche, M, Epps, H, Hosalkar, H, M...

Based on the best current evidence and a systematic review of published studies, 14 recommendations have been created to guide clinical practice and management of supracondylar fractures of the humerus in children.

Clinical Practice Guideline: Treatment of Pediatric Supracondylar Humerus Fractures

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Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman ...

This is an AAOS clinical guideline on the treatment of supracondylar fractures of the humerus in children.

Clinical Practice Guideline: Proximal Humerus Fractures in Children

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Weber, E & Hardeski, DP

This is an AAOS clinical guideline on the pathophysiology and etiology, diagnosis, and management of proximal humerus fractures in children.

Clinical Practice Guideline: Treatment of Distal Radius Fractures

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Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring D, Slutksy DJ, Taras JS

This an an AAOS clinical guideline for pediatric distal radial fractures.