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.



Systematic reviews

Systematic Review: The treatment of displaced supracondylar humerus fractures: evidence-based guideline


Mulpuri, K & Wilkins, K

The guidelines provided answers for the following questions regarding the treatment for type III supracondylar fractures (1) which is the preferred treatment for displaced supracondylar fractures of the humerus: reduction and casting versus closed reduction and percutaneous pinning; (2) which is the preferred method for fixing displaced supracondylar fractures of the humerus: medial (crossed) versus lateral pinning; and lastly, (3) does open reduction cause increased stiffness or have a high rate of complication? The purpose of this paper is to summarize and highlight the major findings from this systematic review.

Systematic Review: Above- or below-elbow casts for distal third forearm fractures in children? A meta-analysis of the literature


Hendrickx, RP, Campo, MM, van Lieshout, AP, Struijs, PA & van den Bekerom, MP

The purpose of this meta-analysis is to investigate whether above- or below-elbow cast should be considered the first-choice for conservative treatment.

Cochrane Systematic Review: Surgical interventions for diaphyseal fractures of the radius and ulna in children


Abraham, A, Kumar, S, Chaudhry, S & Ibrahim, T

Objectives: To assess the effects (benefits and harms) of a) surgical versus non-surgical interventions, and b) different surgical interventions for the fixation of diaphyseal fractures of the forearm bones in children.

Systematic Review: Splinting versus casting of "torus" fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): a literature review


Firmin, F & Crouch, R

Aim: To compare outcomes regarding splinting versus casting of paediatric torus fractures in the ED with the aim of establishing the preferred treatment.