“Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger…DON’T X-RAY”
- 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.
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.
- 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.
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.
- 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