Pediatric Fractures

Initial Examination

X-rays

Complications

Emergencies

Treatment Pearls

Initial Examination

Document the neurovascular status of the limb. A fractured limb should be splinted for comfort and protection before transfer.

Emergencies

  • Joint dislocation – reduce and splint

  • Supracondylar elbow fracture – immediate surgery

  • Open fractures – immediate surgery

  • Femoral neck fractures – immediate surgery

X-rays

  • Include the joint above and below the fracture to avoid missing an associated dislocation.

  • Pediatric patients often are unable to localize pain; another reason for imaging joints above and below area of concern.

  • X-rays should be taken in two planes; i.e. AP and lateral.

  • When diagnosing epiphyseal separation or fractures of unossified epiphyses, obtain comparison limb views.

Treatment Pearls

  • A child’s healing and remodeling capabilities can compensate for imperfect alignment to a much greater degree than an adult.

  • Rapid fracture healing: femur fracture in infant - 3 weeks; 8 year old - 8 weeks.

  • To prevent physical injury, growth plate fractures should be reduced only once. Splint and refer to an orthopedist on an urgent basis.

  • Rotational malalignment and lateral angulation do not self correct. Bayonet apposition and anteroposterior angulation in place of joint motion do tend to correct.

  • Open fracture – use advanced trauma life support (ATLS) guidelines.

  • Be aware of child abuse. If the story does not fit the injury, consider doing entire long bone/body x-rays if child abuse is suspected.

Complications

  • Growth disturbances after epiphyseal plate injuries.

  • Osteomyelitis.

  • Volkmann's ischemia of nerves and muscles.

  • Post-traumatic myositis ossificans.

  • Refracture, deformities.

Reviewed by CDR Wendy Bailey, MC, USN, Pediatric Specialty Leader, Naval Medical Center San Diego, San Diego, CA (1999).

Preface  ·  Administrative Section  ·  Clinical Section

The General Medical Officer Manual , NAVMEDPUB 5134, January 1, 2000
Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This web version of The General Medical Officer Manual, NAVMEDPUB 5134 is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy version, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified. This formatting © 2006 Medical Education Division, Brookside Associates, Ltd. All rights reserved.

Home  ·  Textbooks and Manuals  ·  Videos  ·  Lectures  ·  Distance Learning  ·  Training  ·  Operational Safety  ·  Search


This website is dedicated to the development and dissemination of medical information that may be useful to those who practice Operational Medicine. This website is privately-held and not connected to any governmental agency. The views expressed here are those of the authors, and unless otherwise noted, do not necessarily reflect the views of the Brookside Associates, Ltd., any governmental or private organizations. All writings, discussions, and publications on this website are unclassified.

© 2006 Medical Education Division, Brookside Associates, Ltd. All rights reserved

Other Brookside Products

Contact Us

Advertise on this Site