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 childs 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
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