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.



Key studies

Key Study: Feasibility of a reduction protocol in the emergency department for diaphyseal forearm fractures in children


Pesenti, S, Litzelmann, E, Kahil, M, Mallet, C, Jehanno, P, Mercier, JC, Ilha...

The purpose of this study was to analyze the results of diaphyseal forearm fractures in the emergency department (ED) in children.

Key Study: Using softcast to treat torus fractures in a paediatric emergency department


Callender, O & Koe, S

Guidelines were developed in order to standardise the care for children who attended the ED with a torus fracture.

Key Study: Accuracy of Ultrasonography for Determining Successful Realignment of Pediatric Forearm Fractures


Dubrovsky, AS, Kempinska, A, Bank, I & Mok, E

The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluoroscopy in determining successful realignment of pediatric forearm fractures. The secondary objective is to determine the rate of agreement of ultrasonography and fluoroscopy in real-time by the treating physician.

Key Study: Forearm fractures in children: split opinions about splitting the cast


Schulte, D, Habernig, S, Zuzak, T, Staubl,i G, Altermatt, S, Horst, M & Garci...

Fractures of the forearm are the most common fractures in children. Various methods of cast immobilization have been recommended. Currently, there is still controversy regarding the optimal method of treatment, especially regarding the need for cast splitting.

Key Study: Synthetic versus plaster of Paris casts in the treatment of fractures of the forearm in children: a randomised trial of clinical outcomes and patient satisfaction


Inglis, M, McClelland, B, Sutherland, LM & Cundy, PJ

The aim of this study was to investigate which cast material is superior for the management of these fractures.

Key Study: Soft cast versus rigid cast for treatment of distal radius buckle fractures in children


Witney-Lagen, C, Smith, C & Walsh, G

This study aimed to ascertain whether buckle fractures of the distal radius can be safely and effectively treated in soft cast with only a single orthopaedic outpatient clinic appointment.

Key Study: Pediatric clavicular fractures: assessment of fracture patterns and predictors of complicated outcome


Strauss, BJ, Carey, TP, Seabrook, JA & Lim, R

Study Objectives: The study aim was to identify the radiological and clinical variables that increase the complication rate of clavicular fractures. Identification of these variables would help emergency physicians identify patients who require more thorough follow-up or surgical intervention.

Key Study: Below-elbow cast for metaphyseal both-bone fractures of the distal forearm in children: a randomised multicentre study


Colaris, JW, Biter, LU, Allema, JH, Bloem, RM, van de Ven, CP, de Vries, MR, ...

Minimally displaced metaphyseal both-bone fractures of the distal forearm in children are often treated with an above-elbow cast (AEC). Treatment with a below-elbow cast (BEC) could give more comfort, but might lead to fracture displacement reducing pronation and supination. The purpose of this study was to find out whether BEC causes equal limitation of pronation and supination but with higher comfort level, compared with AEC.

Key Study: Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department


Chaar-Alvarez, FM, Warkentine, F, Cross, K, Herr, S & Paul, RI

Objectives: Ultrasound (US) may be a useful tool for rapidly diagnosing fractures. Our objective was to determine the accuracy of US as compared with radiographs in the detection of nonangulated distal forearm fractures.

Key Study: Bedside ultrasound in the diagnosis of pediatric clavicle fractures


Chien, M, Bulloch, B, Garcia-Filion, P, Youssfi, M, Shrader, MW & Segal, LS

Objective: The objective of the study was to determine the diagnostic accuracy of pediatric emergency physicians in diagnosing clavicle fractures by bedside ultrasound (US).

Key Study: Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial


Boutis, K, Willan, A, Babyn, P, Goeree, R & Howard, A

Minimally angulated fractures of the distal radius are common in children and have excellent outcomes. We conducted a randomized controlled trial to determine whether the use of a prefabricated splint is as effective as a cast in the recovery of physical function.

Key Study: Are frequent radiographs necessary in the management of closed forearm fractures in children?


Bochang, C, Katz, K, Weigl, D, Jie, Y, Zhigang, W & Bar-On, E

A prospective pooled case series was used to assess the value of frequent radiographic examinations during treatment of closed forearm fractures in children from major university pediatric medical centers in Israel and China.

Key Study: A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children


Plint, AC, Perry, JJ, Correll, R, Gaboury, I & Lawton, L

The objective was to determine if children with distal radius and/or ulna buckle fractures treated with a removable splint have better physical functioning than those treated with a short arm cast for 3 weeks.

Key Study: Simple treatment for torus fractures of the distal radius


Davidson, JS, Brown, DJ, Barnes, SN & Bruce, CE

Torus (buckle) fractures of the distal radius are common in childhood. Based on the results of a postal questionnaire and a prospective, randomised trial, we describe a simple treatment for this injury, which saves both time and money.