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Fractures, Pediatric, Emergency Medicine

Adam Z. Barkin Reviewed 06/2017
 


Basics

Description

  • 20% of pediatric patients with acute traumatic injuries will have a fracture

  • Boys have fractures more commonly than girls

  • Anatomy:

    • Diaphysis: Physis to physis; bone shaft

    • Epiphysis: Cart...

Diagnosis

Signs and Symptoms

  • Decreased limb movement, unwilling to use

  • Swelling

  • Tenderness

  • Deformity

  • Ecchymosis

  • Crepitus

  • Limp

  • Abnormal neurovascular status of extremity

  • Compartment syndrome:

    • Severe pain, especi...

Treatment

Pre-Hospital

Immobilization 

Initial Stabilization/Therapy

  • Resuscitation for concurrent injuries

  • Immobilization

Ed Treatment/Procedures

  • Management of life-threatening concurrent injuries

  • Pain contr...

Follow-Up

Disposition

Admission Criteria

  • NAT (or per social services)

  • Open fracture

  • Potential neurovascular compromise/compartment syndrome:

    • Condylar or supracondylar humerus fracture

    • Femoral shaft

Discharge Criteria

Pearls and Pitfalls

  • History is essential in evaluation of NAT

  • Undress patient fully especially if suspicion for NAT

  • Have a low threshold to splint and/or consult orthopedist

  • Pain control is essential and...

Additional Reading

  • Boutis  K. Common pediatric fractures treated with minimal intervention. Pediatr Emerg Care.  2010;26:152–157.

  • Chasm  RM, Swencki  SA. Pediatric orthopedic emergencies. Emerg Me...

Codes

ICD9

  • 803.00 Other closed skull fracture without mention of intracranial injury, unspecified state of consciousness

  • 807.00 Closed fracture of rib(s), unspecified

  • 829.0 Fracture of unspecified bone, ...

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