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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.

BROWSE EVIDENCE REPOSITORY

 

directive clinique

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.

Vue d'ensemble de l'examen systématique

Cochrane Summary: Conservative interventions for shaft fractures of the forearm bones in children

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Madhuri V, Dutt V, Gahukamble AD, Tharyan P

The forearm consists of two bones, the radius and the ulna. Fractures (broken bones) in the middle portion (shaft) of one or both of these bones are common injuries in children. Most of these fractures are treated conservatively (i.e. without surgery). Conservative treatment usually involves gently putting the broken bone back into place (reduction). Part of the arm is then put in a cast to protect and support the broken bones while they heal. There are different ways of immobilising the injured arm. For example, some casts include the elbow whereas others do not. When casts include the elbow, the elbow may be in a bent or extended position. While these fractures usually heal, the results are not always satisfactory and sometimes there are complications. This review aimed to find out which conservative treatment methods give the best results for children with these fractures by looking at the evidence from randomised controlled trials comparing different conservative interventions. While we found two completed trials, both were published only in conference abstracts that failed to provide any usable data. We also found two ongoing trials. In all, the review found no evidence from randomised trials to inform on the best ways to treat these fractures.

Cochrane Summary: Surgical treatment for forearm fractures in children (fractures involving the shafts of the radius and ulna)

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Abraham A, Kumar S, Chaudhry S, Ibrahim T

Fractures of the shafts of the forearm bones in children are common injuries and occur after a fall on an outstretched hand. There are two bones in the forearm: the radius and the ulna. After a fall either one or both bones may fracture. The shape of forearm bones are important for the twisting motion of the hand, such as in receiving change from a shop keeper with an open palm (supination) or turning a key in a door (turning the palm facing down - pronation). Treatment of the forearm fracture aims to restore the shape of the bones such that supination and pronation ability is restored. The first stage of treatment involves manipulating (setting) the bones to the correct shape. This is usually done under anaesthesia. The second stage involves stabilising the fractured bones either with a plaster cast (conservative treatment) or metal implants (surgical treatment). This review aimed to examine the evidence from randomised controlled trials comparing conservative versus surgical methods and trials comparing different surgical methods for treatment of these fractures. We hoped to find which are the best methods in terms of function and complications. In spite of a thorough search we found no evidence from properly conducted studies to help inform decisions on treatment of these fractures.

examen systématique

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

étude clé

Key Study: Cost analysis and performance in distal pediatric forearm fractures: is a short-arm cast superior to a sugar-tong splint?

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Acree JS, Schlechter J, Buzin S

The aim of this study is to compare splint versus cast immobilization for maintaining alignment following closed reduction of distal 1/3 radius and both-bone forearm fractures.

Key Study: Do All Clavicle Fractures in Children Need To Be Managed by Orthopedic Surgeons?

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Adamich J, Howard A, Camp M

Development of evidence-based clinical care pathway can help unnecessary radiation exposure to this patient population and reduce costs to patient families and the health care system.

Key Study: Bivalved Versus Circumferential Cast Immobilization for Displaced Forearm Fractures: A Randomized Clinical Trial to Assess Efficacy and Safety

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Bae DS, Valim C, Connell P, Brustowicz KA, Waters PM

The purpose of this study was to determine the effects of bivalved versus circumferential cast immobilization on maintenance of reduction and associated complications after closed reduction of radius and/or ulna fractures in children.

Key Study: Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures

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Baldwin PC III, Han E, Parrino A, Solomito MJ, Lee MC

The purpose of this study was to determine the rate of cast-related complications when using split or intact casts.

Key Study: Adolescent Distal Humerus Fractures: ORIF Versus CRPP

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Bell P, Scannell BP, Loeffler BJ, Brighton BK, Gaston RG, Casey V, Peters ME,...

The purpose of this study was to review the treatment and outcomes of consecutive series of distal humerus fractures in adolescents and to compare outcomes between patients treated with percutaneous skeletal fixation and those treated with open reduction and fixation.

Key Study: Intravenous regional anaesthesia (Bier's block) for pediatric forearm fractures in a pediatric emergency department-Experience from 2003 to 2014

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Chua ISY, Chong SL, Ong GYK

The objective of the study was to evaluate the efficacy (length of stay in the emergency department and failure rate of Bier's block) and safety profile (death and major complications) of Bier's block in its use for manipulation and reduction of paediatric forearm fractures.

Key Study: Patient and Parent Satisfaction With Sling Use After Pediatric Upper Extremity Fractures: A Randomized Controlled Trial of a Customized Cast-sling Versus Standard Cast and Sling

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Cruz AI Jr, DeFroda SF, Gil JA, Hansen H, Bolous A, Procaccini M, Zonfrillo MR

The purpose of this investigation was to compare patient/parent centered outcomes after the use of a customized sling compared with a standard sling by utilizing a prospective, randomized-controlled trial.

Key Study: Obesity Increases Risk of Loss of Reduction after Casting for Diaphyseal Fractures of the Radius and Ulna in Children: An Observational Cohort Study

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DeFrancesco CJ, Rogers BH, Shah AS

The objective of this study was to determine if high body mass index increases the risk of loss of reduction following closed reduction and casting for displaced concomitant fractures of the radial and ulnar shafts in pediatric patients.

Key Study: The utility of clinical ultrasonography in identifying distal forearm fractures inthe pediatric emergency department

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Galletebeitia Laka I, Samson F, Gorostiza I, Gonzalez A, Gonzalez C

The aim of this study is to evaluate the utility of point-of-care ultrasound for diagnosing distal forearm fractures in pediatric emergency departments.

Key Study: Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures

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Gladstein AZ, Schade AT, Howard AW, Camp MW

The primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment.

Key Study: The Use of Magnetic Resonance Imaging in Management of Minimally Displaced or Nondisplaced Lateral Humeral Condyle Fractures in Children

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Haillotte G, Bachy M, Delpont M, Kabbaj R, Ducou le Pointe H, Vialle R

The purpose of this study was to investigate the use of MRI in diagnosis and therapeutic decision in minimally displaced lateral condyle fractures in children.

Key Study: Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound

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Hedelin H, Tingstrm C, Hebelka H, Karlsson J

The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training.

Key Study: Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents

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Herzog MM, Whitesell RC, Mac LM, Jackson ML, Culotta BA, Axelrod JR, Busch MT...

This study aimed to assess shoulder function in adolescents following shortened clavicle fracture and compare operative versus non-operative treatment.

Key Study: Emerging U.S. National Trends in the Treatment of Pediatric Supracondylar Humeral Fractures

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Holt JB, Glass NA, Bedard NA, Weinstein SL, Shah AS

Understanding national treatment trends will provide important insight into variations in regional treatment standards and help identify areas for improvement in value in care delivery.

Key Study: Outcome of Pediatric Forearm Fracture Reductions Performed by Pediatric Emergency Medicine Providers Compared With Reductions Performed by Orthopedic Surgeons: A Retrospective Cohort Study

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Milner D, Krause E, Hamre K, Flood A

The aim of this study was to describe the outcome differences between board-certified orthopedists and pediatric emergency medicine physicians conducting forearm fracture reductions.

Key Study: Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures

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Morrison T, Carender C, Kilbane B, Liu RW

The current study was conducted to answer 2 questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation : 1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? 2) Is there a difference in the rates of major sedation-related complications?

Key Study: External validation of clinical decision rules for children with wrist trauma

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Mulders MA, Walenkamp MM, Dubois BF, Slaar A, Goslings JC, Schep NW

The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rules in a different cohort of patients.

Key Study: Capitellar Fractures in Children and Adolescents: Classification and Early Results of Treatment

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Murthy PG, Vuillermin C, Naqvi MN, Waters PM, Bae DS

The purpose of this investigation was to characterize capitellar fracture patterns in children and adolescents and to assess early clinical and radiographic treatment outcomes.

Key Study: Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes

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Poonai N, Myslik F, Joubert G, Fan J, Misir A, Istasy V, Columbus M, Soegtrop...

The objectives of the study were to examine the test performance characteristics of point-of-care ultrasound for nonangulated distal forearm injuries in children and compare to x-ray with respect to pain, caregiver satisfaction, and procedure duration.

Key Study: Bedside Ultrasound vs X-Ray for the Diagnosis of Forearm Fractures in Children

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Rowlands R, Rippey J, Tie S, Flynn J

The primary aim of this study was to determine if a cohort of physicians with little or no previous experience with US could, after a short training program, safely exclude forearm fractures in children.

Key Study: Relevance of MRI for management of non-displaced lateral humeral condyle fractures in children

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Thvenin-Lemoine C, Salanne S, Pham T, Accadbled F, Baunin C, Sales De Gauzy J

The primary objective of this study was to evaluate the ability of MRI to determine whether the fracture line is complete or incomplete in cases of non-displaced lateral humeral condyle fractures in children.

Key Study: Childhood Obesity Increases the Risk of Failure in the Treatment of Distal Forearm Fractures

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Auer RT, Mazzone P, Robinson L, Nyland J, Chan G

A retrospective case-controlled study was conducted to determine whether obesity is an independent risk factor for the failure of closed reduction and casting.

Key Study: Influence of Immobilization Time on Functional Outcome in Radial Neck Fractures in Children

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Badoi A, Frech-Drfler M, Hcker FM, Mayr J

The aim of the study was to analyze the influence of immobilization time on functional outcome.

Key Study: Functional Outcomes After Treatment of Scaphoid Fractures in Children and Adolescents

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Bae DS, Gholson JJ, Zurakowski D, Waters PM

The purpose of this investigation was to characterize the functional outcomes of children and adolescents treated for scaphoid fractures.

Key Study: Diagnostic value of ultrasonography in elbow trauma in children: Prospective study of 34 cases

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Burnier M, Buisson G, Ricard A, Cunin V, Pracros JP, Chotel F

This study evaluated the diagnostic contribution of ultrasonography in the treatment of acute elbow injuries in children and the strategic and economic impact of using this tool alongside radiography.

Key Study: Adherence behavior in an acute pediatric hand trauma population: A pilot study of parental report of adherence levels and influencing factors

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Cole T, Underhill A, Kennedy S

The hand is a common site of injury in children; however, little is known regarding adherence to hand trauma management in this population.

Key Study: Forearm-Based Ulnar Gutter versus Hand-Based Thermoplastic Splint for Pediatric Metacarpal Neck Fractures: A Blinded, Randomized Trial

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Davison PG, Boudreau N, Burrows R, Wilson KL, Bezuhly M

Primary outcome of this study was the difference in active range of motion between a conventional forearm-based ulnar gutter or hand-based thermoplastic splint.

Key Study: Reduced Length of Stay and Adverse Events Using Bier Block for Forearm Fracture Reduction in the Pediatric Emergency Department

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Fauteux-Lamarre E, Burstein B, Cheng A, Bretholz A

This study sought to compare Bier block and procedural sedation for forearm fracture reduction.

Key Study: MRI shows a high incidence of carpal fractures in children with posttraumatic radial-sided wrist tenderness

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Jrgsholm P, Thomsen N, Besjakov J, Abrahamsson S, Bjrkman A

This study describes fractures revealed by magnetic resonance imaging (MRI) in a prospective population of children and adolescents with posttraumatic radial-sided wrist tenderness, and compare the diagnostic value of radiographs and computed tomography (CT) with that of MRI.

Key Study: Primary Care Physician Follow-up of Distal Radius Buckle Fractures

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Koelink E, Schuh S, Howard A, Stimec J, Barra L, Boutis K

The main objective was to determine the proportion of children referred to a primary care provider (PCP) for follow-up of a distal radius buckle fracture who subsequently did not deviate from this reassessment strategy.

Key Study: Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department: a 2.5-year study

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Kurien T, Price KR, Pearson RG, Dieppe C, Hunter JB

This study presents the results of managing children's fracture of the distal forearm in the ED using intranasal diamorphine and Entonox to allow manipulation and discharge on the same day.

Key Study: Acute ischemia and pink pulseless hand in 68 of 404 gartland type III supracondylar humeral fractures in children: Urgent management and therapeutic consensus

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Louahem D, Cottalorda J

The purpose of this retrospective study was to describe our strategy and to determine the guidelines of therapeutic consensus.

Key Study: Radiographic Evaluation During Treatment of Pediatric Forearm Fractures: Implications on Clinical Care and Cost

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Luther G, Miller P, Waters PM, Bae DS

The purpose of this study was to analyze the clinical utility and cost of the week 4 radiograph following closed treatment of pediatric forearm fractures.

Key Study: Introduction of a simple guideline to improve neurological assessment in paediatric patients presenting with upper limb fractures

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Marsh AG, Robertson JS, Godman A, Boyle J, Huntley JS

This study aimed to assess the improvement in documented neurological examination for children presenting with upper limb fractures following introduction of a simple guideline.

Key Study: Effect of a Computerized Reminder on Splinting of Pediatric Upper Limb Fractures in the Emergency Department

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Mills E, Craig S, Oakley E

The primary objective was to assess if a computerized pop-up reminder increased splint application before X-ray in pediatric emergency department patients with deformed upper limb fractures.

Key Study: Is softcast (3M) strong enough for potentially unstable paediatric forearm fractures?

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Patel N, Wilson L, Wansbrough G

This study aimed to investigate whether the mechanical properties of Softcast are sufficient to stabilize a paediatric forearm fracture and protect the patient from further injury against clinically defined failure parameters.

Key Study: Postsplinting x-rays of nondisplaced hand, wrist, ankle, and foot fractures are unnecessary

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Schuld JC, Volker ML, Anderson SA, Zwank MD

The objectives of this study were to determine how often X-rays are obtained after splinting of non-displaced fractures to identify if postsplinting X-rays change treatment management in the ED, and identify if there are medical complications at follow-up.

Key Study: A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

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Slaar A, Walenkamp MM, Bentohami A, Maas M, van Rijn RR, Steyerberg EW, Jager...

The objective of this study was to develop and validate a clinica decision rule to decide whether radiography in children with wrist trauma is required.

Key Study: Reducing Cost and Radiation Exposure During the Treatment of Pediatric Greenstick Fractures of the Forearm

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Ting BL, Kalish LA, Waters PM, Bae DS

The purpose of this investigtion was to evaluate the LOR rate requiring intervention - including either repeat closed reduction or surgical reduction and fixation- following closed reduction and cast immobilization of pediatric greenstick forearm fractures.

Key Study: Long-term Functional Results of Neurological Complications of Pediatric Humeral Supracondylar Fractures

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Valencia M, Moraleda L, Dez-Sebastin J

The aim of this study is to report the long-term functional outcome of neurological complications associated to pediatric supracondylar fractures.

Key Study: Using softcast to treat torus fractures in a paediatric emergency department

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Callender O, Koe S

Wrist torus fractures in children are a frequent reason for Emergency Department (ED) visits. Torus fractures traditionally were treated with a backslab cast in the Children's ED and then referred to the Fracture Clinic. Guidelines were developed in order to standardise the care for children who attended the ED with a torus fracture. All patients who were seen & treated by the Advanced Nurse Practitioner (ANP) over a one year period with a diagnosis of a torus fracture were treated with immobilisation in a softcast. 119 patients met the criteria for inclusion. There were no adverse events recorded and no patient required subsequent visits to the Fracture Clinic. There was a cost savings of 18,596 as compared with the normal referral pathway to the Fracture Clinic.

Key Study: Feasibility of a reduction protocol in the emergency department for diaphyseal forearm fractures in children

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Pesenti S, Litzelmann E, Kahil M, Mallet C, Jehanno P, Mercier JC, Ilharrebor...

The purpose of this study was to analyze the results of diaphyseal forearm fractures in the emergency department in children.

Key Study: Accuracy of ultrasonography for determining successful realignment of pediatric forearm fractures

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Dubrovsky AS, Kempinska A, Bank I, Mok E

The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluroscoppy in determining successful realignment of pediatric forearm fractures.

Key Study: Synthetic versus plaster of Paris casts in the treatment of fractures of the forearm in children: a randomised trial of clinical outcomes and patient satisfaction

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Inglis M, McClelland B, Sutherland LM, Cundy PJ

The aim of this study was to investigate which cast material is superior for the management of fractures of the forearm.

Key Study: Below-elbow cast for metaphyseal both-bone fractures of the distal forearm in children: a randomised multicentre study

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Colaris JW, Biter LU, Allema JH, Bloem RM, van de Ven CP, de Vries MR, Kerver...

The purpose of this study was to find out whether below-elbow casts cause equal limitation of pronation and supination but with higher comfort level, compared with above-elbow casts.

Key Study: Bedside ultrasound in the diagnosis of pediatric clavicle fractures

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Chien M, Bulloch B, Garcia-Filion P, Youssfi M, Shrader MW, Segal LS

The objective of this study was to determine the diagnostic accuracy of pediatric emergency physicians in diagnosing clavicle fractures by bedside ultrasound.

Key Study: Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial

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Boutis K, Willan A, Babyn P, Goeree R, Howard A

This study aimed to determine whether the use of a prefabricated splint is as effective as a cast in the recovery of physical function.

Key Study: A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children

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Plint AC, Perry JJ, Correll R, Gaboury I, Lawton L

The objective of this study was to determine if children with distal radius and/or ulna buckle fractures treated with a removable splint have better physical functioning than those treated with a short arm cast for 3 weeks.

Key Study: Simple treatment for torus fractures of the distal radius

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Davidson JS, Brown DJ, Barnes SN, Bruce CE

Based on the results of a postal questionnaire and a prospective randomised trial, this study descibes a simple treatement for a torus fracture of the distal radius, which saves both time and money.