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.
Clinical Practice Guideline: Paediatric fracture guidelines - Hip and proximal femur
Victorian Paediatric Orthopaedic Network
Victorian Paediatric Orthopaedic Network
Summary and classification of hip and proximal femur fractures.
Clincial Practice Guideline: Paediatric fracture guidelines - Femoral shaft (diaphysis)
Victorian Paediatric Orthopaedic Network
Victorian Paediatric Orthopaedic Network
Summary of femoral shaft fractures, ED management, and follow-up.
Clincial Practice Guideline: Paediatric fracture guidelines - Tibial shaft (diaphysis)
Victorian Paediatric Orthopaedic Network
Victorian Paediatric Orthopaedic Network
Summary of tibial shaft fracture, ED management, and follow-up.
Clinical Practice Guideline: Paediatric fracture guidelines - Ankle (distal tibial and fibula physeal)
Victorian Paediatric Orthopaedic Network
Victorian Paediatric Orthopaedic Network
Summary of distal tibia and-or fibula physeal fractures, ED management, and follow-up.
Clinical Practice Guideline: Treatment of Pediatric Diaphyseal Femur Fractures
Jevsevar DS & Shea K
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
Mckinney, B & Roth, C
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
Kocher, MS, Sink, EL, Blasier, RD, Luhmann, SJ, Mehlman, CT, Scher, DM, Matheney, T & Sanders, JO
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
Hoernschemeyer, DG, Khazzam, M & Hoffinger, SA
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.
Clinical Practice Guideline: Pediatric Femoral Shaft Fractures
Anglen, JO & Flynn, JM
Anglen, JO & Flynn, JM
This is an AAOS clinical guideline on the pathophysiology, classification, diagnosis, and management of pediatric femoral shaft fractures.
Clincial Practice Guideline: Ankle Fractures in Adolescents
Rieger, KJ, Hyman, J & Vitale, M
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.
Clinical Practice Guideline: Paediatric fracture guidelines - Hip and proximal femur
Victorian Paediatric Orthopaedic Network
Victorian Paediatric Orthopaedic Network
Summary and classification of hip and proximal femur fractures.
Clincial Practice Guideline: Paediatric fracture guidelines - Femoral shaft (diaphysis)
Victorian Paediatric Orthopaedic Network
Victorian Paediatric Orthopaedic Network
Summary of femoral shaft fractures, ED management, and follow-up.
Clincial Practice Guideline: Paediatric fracture guidelines - Tibial shaft (diaphysis)
Victorian Paediatric Orthopaedic Network
Victorian Paediatric Orthopaedic Network
Summary of tibial shaft fracture, ED management, and follow-up.
Clinical Practice Guideline: Paediatric fracture guidelines - Ankle (distal tibial and fibula physeal)
Victorian Paediatric Orthopaedic Network
Victorian Paediatric Orthopaedic Network
Summary of distal tibia and-or fibula physeal fractures, ED management, and follow-up.
Clinical Practice Guideline: Treatment of Pediatric Diaphyseal Femur Fractures
Jevsevar DS & Shea K
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
Mckinney, B & Roth, C
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
Kocher, MS, Sink, EL, Blasier, RD, Luhmann, SJ, Mehlman, CT, Scher, DM, Matheney, T & Sanders, JO
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
Hoernschemeyer, DG, Khazzam, M & Hoffinger, SA
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.
Clinical Practice Guideline: Pediatric Femoral Shaft Fractures
Anglen, JO & Flynn, JM
Anglen, JO & Flynn, JM
This is an AAOS clinical guideline on the pathophysiology, classification, diagnosis, and management of pediatric femoral shaft fractures.
Clincial Practice Guideline: Ankle Fractures in Adolescents
Rieger, KJ, Hyman, J & Vitale, M
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.
Cochrane Summary: Different methods of treating fractures of the shaft of the thigh bone in children and adolescents
Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P
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.
Cochrane Summary: Different methods of treating fractures of the shaft of the thigh bone in children and adolescents
Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P
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: Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis
Chartier, L B, Bosco, L, Lapointe-Shaw, L and Chenkin, J
Chartier, L B, Bosco, L, Lapointe-Shaw, L and Chenkin, J
This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs.
Cochrane Systematic Review: Interventions for treating femoral shaft fractures in children and adolescents
Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P
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
Dowling, S, Spooner, CH, Liang, Y, Dryden, DM, Friesen, C, Klassen, TP & Wright, RB
Dowling, S, Spooner, CH, Liang, Y, Dryden, DM, Friesen, C, Klassen, TP & ...
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.
Systematic Review: Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis
Chartier, L B, Bosco, L, Lapointe-Shaw, L and Chenkin, J
Chartier, L B, Bosco, L, Lapointe-Shaw, L and Chenkin, J
This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs.
Cochrane Systematic Review: Interventions for treating femoral shaft fractures in children and adolescents
Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P
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
Dowling, S, Spooner, CH, Liang, Y, Dryden, DM, Friesen, C, Klassen, TP & Wright, RB
Dowling, S, Spooner, CH, Liang, Y, Dryden, DM, Friesen, C, Klassen, TP & ...
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.
Key Study: Do toddler's fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?
Adamich, J S and Camp, M W
Adamich, J S and Camp, M W
This publication provies an evidence-based pathway can help prevent this overtreatment, reduce unnecessary radiation exposure and decrease the financial burden on families and the healthcare system.
Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department
Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, Berg, A M, Longjohn, M and Kink, R J
Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, ...
The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.
Key Study: Pediatric Femoral Shaft Fractures: A Multicenter Review of the AAOS Clinical Practice Guidelines Before and After 2009
Roaten, J D, Kelly, D M, Yellin, J L, Flynn, J M, Cyr, M, Garg, S, Broom, A, Andras, L M and Sawyer, J R
Roaten, J D, Kelly, D M, Yellin, J L, Flynn, J M, Cyr, M, Garg, S, Broom, A, ...
To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013).
Key Study: Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?
Hirsch, D G, Tyo, J and Wrotniak, B H
Hirsch, D G, Tyo, J and Wrotniak, B H
The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.
Key Study: Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain?
Boutis, K, Plint, A, Stimec, J, et al
Boutis, K, Plint, A, Stimec, J, et al
To determine the frequency of SH1DF using magnetic resonance imaging (MRI) and compare the functional recovery of children with fractures identified by MRI vs those with isolated ligament injuries.
Key Study: Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments
Boutis, K, von Keyserlingk, C, Willan, A, Narayanan, UG, Brison, R, Grootendorst, P, Plint AC, Parker, M & Goeree, R
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
Gilbert, SR, MacLennan, PA, Backstrom, I, Creek, A & Sawyer, J
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: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway
Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M
Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M
This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.
Key Study: Effect of the low risk ankle rule on the frequency of radiography in children with ankle injuries
Boutis, K, Grootendorst, P, Willan, A, Plint, AC, Babyn, P, Brison, RJ, Sayal, A, Parker, M, Mamen, N, Schuh, S, Grimshaw, J, Johnson, D & Narayanan, U
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
Barnett, PL, Lee, MH, Oh, L, Cull, G & Babl, F
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
Gravel, J, Hedrei, P, Grimard, G & Gouin, S
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
Boutis, K, Willan, AR, Babyn, P, Narayanan, UG, Alman, B & Schuh, S
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
Bulloch, B, Neto, G, Plint, A, Lim, R, Lidman, P, Reed, M, Nijssen-Jordan, C, Tenenbein, M, Klassen, TP, Bhargava, R & Pediatric Emergency Researchers of...
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
Plint, AC, Bulloch, B, Osmond, MH, Stiell, I, Dunlap, H, Reed, M, Tenenbein, M & Klassen, TP
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.
Key Study: Do toddler's fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?
Adamich, J S and Camp, M W
Adamich, J S and Camp, M W
This publication provies an evidence-based pathway can help prevent this overtreatment, reduce unnecessary radiation exposure and decrease the financial burden on families and the healthcare system.
Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department
Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, Berg, A M, Longjohn, M and Kink, R J
Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, ...
The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.
Key Study: Pediatric Femoral Shaft Fractures: A Multicenter Review of the AAOS Clinical Practice Guidelines Before and After 2009
Roaten, J D, Kelly, D M, Yellin, J L, Flynn, J M, Cyr, M, Garg, S, Broom, A, Andras, L M and Sawyer, J R
Roaten, J D, Kelly, D M, Yellin, J L, Flynn, J M, Cyr, M, Garg, S, Broom, A, ...
To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013).
Key Study: Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?
Hirsch, D G, Tyo, J and Wrotniak, B H
Hirsch, D G, Tyo, J and Wrotniak, B H
The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.
Key Study: Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain?
Boutis, K, Plint, A, Stimec, J, et al
Boutis, K, Plint, A, Stimec, J, et al
To determine the frequency of SH1DF using magnetic resonance imaging (MRI) and compare the functional recovery of children with fractures identified by MRI vs those with isolated ligament injuries.
Key Study: Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments
Boutis, K, von Keyserlingk, C, Willan, A, Narayanan, UG, Brison, R, Grootendorst, P, Plint AC, Parker, M & Goeree, R
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
Gilbert, SR, MacLennan, PA, Backstrom, I, Creek, A & Sawyer, J
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: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway
Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M
Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M
This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.
Key Study: Effect of the low risk ankle rule on the frequency of radiography in children with ankle injuries
Boutis, K, Grootendorst, P, Willan, A, Plint, AC, Babyn, P, Brison, RJ, Sayal, A, Parker, M, Mamen, N, Schuh, S, Grimshaw, J, Johnson, D & Narayanan, U
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
Barnett, PL, Lee, MH, Oh, L, Cull, G & Babl, F
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
Gravel, J, Hedrei, P, Grimard, G & Gouin, S
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
Boutis, K, Willan, AR, Babyn, P, Narayanan, UG, Alman, B & Schuh, S
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
Bulloch, B, Neto, G, Plint, A, Lim, R, Lidman, P, Reed, M, Nijssen-Jordan, C, Tenenbein, M, Klassen, TP, Bhargava, R & Pediatric Emergency Researchers of...
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
Plint, AC, Bulloch, B, Osmond, MH, Stiell, I, Dunlap, H, Reed, M, Tenenbein, M & Klassen, TP
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.