“Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger…DON’T X-RAY”
Fractures
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Olecranon Fractures
- Unstable fractures require emergent orthopedic consultation for operative fixation.
- Apply splint at 50-90% flexion and analgesia.
- Intravenous antibiotics for open or suspected fractures.
- Stable, nondisplaced fractures with intact extensor function
- Immobilized in a long arm posterior splint with 90 degrees of flexion, neutral forearm
- Orthopedic follow-up within 1-2 days.
Paediatric Elbow Injuries
CRITOE gives us the order of ossification for the pediatric elbow – capitellum, radial head, internal epicondyle, trochlea, external epicondyle, and olecranon — typically occurring at year 1, 3, 5, 7, 9, and 11 – remember the order is the most important thing – all ossification centers should be accounted for. Make sure one is not missing – or where one has been “created” traumatically.
Forearm Fractures
- Night stick Injuries
- Monteggia Fractures
- Galleazzi Fractures
Compartment Syndrome
- Compartment syndrome is a life and limb threatening emergency that requires early recognition, prompt diagnosis and immediate management with fasciotomy
- While clinical evaluation is flawed, pain out of proportion to injury and pain with passive stretch of muscles within the compartment are the best screening tools.
- Do not wait for the development of pallor, absence of pulse or paralysis to consult surgery. These are late findings that may only arise once the limb is non-salvageable.
- In unconscious patients, there should be a low threshold to measure compartment pressure in patients who are at risk as clinical signs cannot be evaluated
- When measuring compartment pressures, look for an absolute pressure > 30 mm Hg and perfusion pressure (DBP – compartment pressure) of < 30 mm Hg. All patients with a clinical suspicion and normal pressures should have repeat pressures measured.
Supracondylar Fracture
Subtle radiographic findings
- Displaced Anterior Fat Pad (Sail Sign)
- Any Posterior Fat Pad
- Anterior Humeral Line not intersecting the middle third of the capitellum.
- Radiocapitellar line not interesting the middle third of the capitellum.
Lover fracture
A lover fracture, also known as Don Juan fracture, is a type of calcaneal fracture. They may be intra- or extra-articular.
The name lover fracture is derived from the fact that a suitor may jump from great heights while trying to escape from the lover’s spouse. There is an important association between lover fractures and burst fractures of the lumbar spine.
Open Fractures
- Prioritize ABCs and systematic evaluation of the trauma patient with an open fracture as one third of these patients have multiple injuries
- Assess neurovascular status and immediately reduce and immobilize if compromised
- Give appropriate antibiotics as soon as possible
- Consult orthopedics for operative management as soon as possible