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: Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents-A systematical review and meta-analysis


Hohloch L, Eberbach H, Wagner FC, Strohm PC, Reising K, Sdkamp NP, Zwingmann J

The aim of this systematic review was to gather the best evidence of different treatment methods and their associated functional outcome, complication rates, rates of limb length discrepancies and radiological outcome for proximal humerus fractures in children and adolescents.

Systematic Review: Outcomes of Nonoperative Pediatric Medial Humeral Epicondyle Fractures With and Without Associated Elbow Dislocation


Knapik DM, Fausett CL, Gilmore A, Liu RW

This systematic review provides a comparative investigation assessing outcomes after nonoperative treatment based on the presence or absence of elbow islocation.

Review: Pediatric orthopedic injuries: evidence-based management in the emergency department


Lien J

This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities.

Review: When is it ok to use a splint versus cast and what remodeling can one expect for common pediatric forearm fractures


Runyon RS, Doyle SM

The purpose of this review is to provide an overview of common pediatric forearm fractures, clarify the descriptions used to identify and therby appropriately treat them with a splint or cast, and explain osseous remodeling that is unique to the skeletally immature.

Systematic Review: Management Modalities and Outcomes Following Acute Scaphoid Fractures in Children: A Quantitative Review and Meta-Analysis


Shaterian A, Santos PJF, Lee CJ, Evans GRD, Leis A

The objective of this study was to compare clinical outcomes following different treatment modalities for pediatric scaphoid fractures.

Systematic Review: Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Controlled Trials


Woltz S, Krijnen P, Schipper IB

The aim was to analyze whether patients with a displaced midshaft clavicular fracture are best managed with plate fization or nonoperative treatment with respect to nonunion, secondary operations, and functional outcome, by evaluating all available randomized controlled trials on this subject.

Systematic Review: Conservative Management of Minimally Displaced (?2 mm) Fractures of the Lateral Humeral Condyle in Pediatric Patients: A Systematic Review


Knapik DM, Gilmore A, Liu RW

This systematic review aims to provide the ideal treatment for minimally displaced fractures (measuring ≤2 mm)


Review: Buckle fractures of the distal radius in children


Ben-Yakov M, Boutis K

This study describes treatment options for buckle fractures of the distal radius in children.

Systematic Review: Ultrasound for Distal Forearm Fracture: A Systematic Review and Diagnostic Meta-Analysis


Douma-den Hamer D, Blanker MH, Edens MA, Buijteweg LN, Boomsma MF, van Helden...

The study objective was to determine the diagnostic accuracy of ultrasound for detecting distal forearm fractures.

Systematic Review: A systematic review of alternative splinting versus complete plaster casts for the management of childhood buckle fractures of the wrist


Hill CE, Masters JP, Perry DC

A systematic review was performed to analyze the complications of alternatic splinting compared to traditional management.

Systematic Review: Management of Pediatric Forearm Torus Fractures: A Systematic Review and Meta-Analysis


Jiang N, Cao ZH, Ma YF, Lin Z, Yu B

The aim of this study was to compare, in a systematic review, clinical efficacy of rigid cast with nonrigid methods for immobilization of the pediatric forearm torus fractures.

Systematic Review: Ultrasound in the Diagnostics of Metaphyseal Forearm Fractures in Children: A Systematic Review and Cost Calculation


Katzer C, Wasem J, Eckert K, Ackermann O, Buchberger B

This is a systematic review of clinical studies evaluating ultrasound as a possible alternative to radiographs in diagnosing metaphyseal forearm fractures in children.

Systematic Review: Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures: A Systematic Review


Larsen MC, Bohm KC, Rizkala AR, Ward CM

This systematic review was conducted of studies examining the radiographic and clinical outcomes of nonoperatively managed SH II distal radius fractures.

Cochrane Systematic Review: Conservative interventions for treating middle third clavicle fractures in adolescents and adults


Lenza M, Faloppa F

The objective was to evaluate the effects (benefits and harms) of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults.

Review: Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations


Pace JL

Pediatric and adolescent forearm fractures continue to present treatment challenges. Despite high-level evidence to the contrary, traditional guidelines for nonsurgical treatment have been challenged in favor of surgical intervention, but it is unclear if this results in improved outcomes. Recent evidence suggests that certain open fractures in children may be successfully treated nonsurgically. Good results have been achieved with closed reduction and appropriate casting and clinical follow-up. Further research investigating functional outcomes into adulthood is needed

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


Mulpuri K, Wilkins K

The purpose of this paper is to summarize and highlight the major findings from the systematic review that developed a clinical practice guideline from the American Academy of Orthopaedic Surgeons regarding treatment for type III supracondylar fractures.

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


Abraham A, Kumar S, Chaudhry S, Ibrahim T

The objective was 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: 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.