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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.

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Clinical guidelines

POSNA Study Guide: Upper Extremity Topics

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Pediatric Orthopaedic Society of North America

The POSNA Study Guide provides an overview of practice points related to fractures and other pediatric orthopaedic injuries of the upper extremity.

Clinical Practice Guideline: Management of Pediatric Supracondylar Humerus Fractures with Vascular Injury

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Sanders JO, Heggeness MH, Murray JN, Pezold RC, Sevarino KS

Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions for pediatric supracondylar humerus fractures with vascular injury.

Paediatric Orthopaedic Pathways: Shoulder girdle and arm

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Camp M & SickKids

The SickKids Paediatric Orthopaedic Pathways (SKPOPs) are user-friendly clinical pathways that are systematically developed, and where possible, evidence-based. These pathways have been developed in collaboration with the Royal Childrens Hospital in Melbourne, Australia. The SKPOPs aim to assist primary-care physicians, emergency room physicians and orthopaedic surgeons in making decisions about appropriate and effective care for their patients.

Paediatric Orthopaedic Pathways: Elbow

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Camp M & SickKids

The SickKids Paediatric Orthopaedic Pathways (SKPOPs) are user-friendly clinical pathways that are systematically developed, and where possible, evidence-based. These pathways have been developed in collaboration with the Royal Childrens Hospital in Melbourne, Australia. The SKPOPs aim to assist primary-care physicians, emergency room physicians and orthopaedic surgeons in making decisions about appropriate and effective care for their patients.

Paediatric Orthopaedic Pathways: Forearm and wrist

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Camp M & SickKids

The SickKids Paediatric Orthopaedic Pathways (SKPOPs) are user-friendly clinical pathways that are systematically developed, and where possible, evidence-based. These pathways have been developed in collaboration with the Royal Childrens Hospital in Melbourne, Australia. The SKPOPs aim to assist primary-care physicians, emergency room physicians and orthopaedic surgeons in making decisions about appropriate and effective care for their patients.

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 Guidelines: Paediatric fracture guidelines - Clavicle

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Victorian Paediatric Orthopaedic Network

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

Clinical Practice Guidelines: Paediatric fracture guidelines - Elbow

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Victorian Paediatric Orthopaedic Network

Clinical practice guidelines: Elbow fractures

Clinical Practice Guidelines: 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 Guidelines: AAOS Appropriate Use Criteria: Management of Pediatric Supracondylar Humerus Fractures

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Park MJ, Ho CA, Larson AN

The American Academy of Orthopaedic Surgeons approved appropriate use criteria for the treatment of pediatric supracondylar humerus fractures in an effort to assist the clinician in caring for these injuries.

Clinical Practice Guidelines: Management of Pediatric Supracondylar Humerus Fractures

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Heggeness MH, Sanders JO, Murray J, Pezold R, Sevarino KS

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria on the Management of Pediatric Supracondylar Humerus Fractures (PSHF). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions

Clinical Practice Guidelines: 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, Mehlman ...

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 Guidelines: The treatment of pediatric supracondylar humerus fractures: Evidence-Based Guideline and Evidence Report

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

This clinical practice guideline is based on a systematic review of published studies on the treatment of supracondylar fractures of the humerus in children. In addition to providing practice recommendations, this guideline highlights gaps in the literature and areas that require future research.

Clinical Practice Guidelines: Treatment of Distal Radius Fractures: Guideline and Evidence Report

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Lichtman DM, Randipsingh RR, Boyer MI, Putnam MD, Ring D, Slutsky DJ, Taras JS

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