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Lower 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

 

En bref

Bottom Line Recommendations: Fractures

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Boutis, K, Camp, M & TREKK Network

The purpose of this document is to provide healthcare professionals with key facts and recommendations for the diagnosis and treatment of fractures in children. Published online: November 2015.

Recommendations de base: Fractures chez l'enfant

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Boutis, K, Camp, M & TREKK Network

Bottom line recommendations for the treatment and management of pediatric fractures - French. Published online: December, 2015.

directive clinique

Clinical Practice Guideline: Paediatric fracture guidelines - Hip and proximal femur

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Victorian Paediatric Orthopaedic Network

Summary and classification of hip and proximal femur fractures.

Clinical Practice Guideline: Paediatric fracture guidelines - Ankle (distal tibial and fibula physeal)

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Victorian Paediatric Orthopaedic Network

Summary of distal tibia and-or fibula physeal fractures, ED management, and follow-up.

Clincial Practice Guideline: Paediatric fracture guidelines - Femoral shaft (diaphysis)

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Victorian Paediatric Orthopaedic Network

Summary of femoral shaft fractures, ED management, and follow-up.

Clincial Practice Guideline: Paediatric fracture guidelines - Tibial shaft (diaphysis)

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Victorian Paediatric Orthopaedic Network

Summary of tibial shaft fracture, ED management, and follow-up.

Clinical Practice Guideline: Treatment of Pediatric Diaphyseal Femur Fractures

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Jevsevar DS & Shea K

This is an AAOS clinical guideline on the treatment of pediatric diaphyseal femur fractures (PDFF).

Clinical Practice Guideline: Apophyseal Avulsion Fractures of the Pelvis and Lower Extremity

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Mckinney, B & Roth, C

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of apophyseal avulsion fractures of the Pelvis and lower extremity.

Clinical Practice Guideline: AAOS clinical practice guideline: the treatment of pediatric diaphyseal femur fractures

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Kocher, MS, Sink, EL, Blasier, RD, Luhmann, SJ, Mehlman, CT, Scher, DM, Mathe...

This is a summary of the recommendations in the AAOS clinical practice guideline, The Treatment of Pediatric Diaphyseal Femur Fractures.

Clinical Practice Guideline: Tibial Shaft Fractures

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Hoernschemeyer, DG, Khazzam, M & Hoffinger, SA

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of tibial shaft fractures.

Clincial Practice Guideline: Ankle Fractures in Adolescents

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Rieger, KJ, Hyman, J & Vitale, M

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of ankle fractures in adolescents.

Résumé de l'examen systématique

Cochrane Summary: Different methods of treating fractures of the shaft of the thigh bone in children and adolescents

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Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P

Objective: To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents.

examen systématique

Cochrane Systematic Review: Interventions for treating femoral shaft fractures in children and adolescents

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Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P

Objective: To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents.

Systematic Review: Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis

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Dowling, S, Spooner, CH, Liang, Y, Dryden, DM, Friesen, C, Klassen, TP & Wrig...

Objective: To conduct a systematic review to determine the diagnostic accuracy of the Ottawa Ankle Rules (OAR) to exclude ankle and midfoot fractures in children and the extent to which x-ray use could be reduced without missing significant fractures.

étude clé

Key Study: Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments

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Boutis, K, von Keyserlingk, C, Willan, A, Narayanan, UG, Brison, R, Grootendo...

Objective: To examine the costs and consequences of implementing the Low Risk Ankle Rule.

Key Study: Altered lower extremity fracture characteristics in obese pediatric trauma patients

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Gilbert, SR, MacLennan, PA, Backstrom, I, Creek, A & Sawyer, J

Objective: To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese versus nonobese pediatric trauma patients.

Key Study: Effect of the low risk ankle rule on the frequency of radiography in children with ankle injuries

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Boutis, K, Grootendorst, P, Willan, A, Plint, AC, Babyn, P, Brison, RJ, Sayal...

Objective: To evaluate the effectivness of the Low Risk Ankle Rule in reducing the frequency of radiography in children with ankle injuries.

Key Study: Functional outcome after air-stirrup ankle brace or fiberglass backslab for pediatric low-risk ankle fractures: a randomized observer-blinded controlled trial

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Barnett, PL, Lee, MH, Oh, L, Cull, G & Babl, F

Objective: To determine if the below-knee fiberglass posterior splint was as effective as the Air-Stirrup ankle brace in returning children with a low risk ankle fracture to their normal level of activity.

Key Study: Prospective validation and head-to-head comparison of 3 ankle rules in a pediatric population

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Gravel, J, Hedrei, P, Grimard, G & Gouin, S

Objective: To determine the criterion validity of three rules for predicting clinically important ankle fractures in children.

Key Study: A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures

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Boutis, K, Willan, AR, Babyn, P, Narayanan, UG, Alman, B & Schuh, S

Objective: To determine whether children who have low-risk ankle fractures that are treated with a removable ankle brace have at least as effective a recovery of physical function as those that are treated with a cast.

Key Study: Validation of the Ottawa Knee Rule in children: a multicenter study

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Bulloch, B, Neto, G, Plint, A, Lim, R, Lidman, P, Reed, M, Nijssen-Jordan, C,...

Objectives: To determine the sensitivity and specificity of the Ottawa Knee Rules when they were applied to children, and to determine post hoc whether use of the rules would reduce the number of knee radiographs ordered.

Key Study: Validation of the Ottawa Ankle Rules in children with ankle injuries

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Plint, AC, Bulloch, B, Osmond, MH, Stiell, I, Dunlap, H, Reed, M, Tenenbein, ...

Objectives: To determine the sensitivity and specificity of the Ottawa Ankle Rules in children and to determine the potential change in x-ray utilization.