Fractures and dislocations (peds)

Clavicle & Shoulder

Clavicle fracture

treatment: Sling/swathe x3 weeks, no sports x3 weeks

Consult ortho immediately for neurovascular compromise

Shoulder dislocation

Usually anterior/inferior, always get axillary view film

treatment: Closed reduction, sling/swathe for several weeks with ortho outpatient follow up due to high risk of recurrence

If posterior dislocation or neurovascular compromise, consult ortho immediately


Proximal humerus fracture

Generally can tolerate >50° angulation

Classification - using the Neer classification system to divide humerus into 4 parts:

  • greater tuberosity
  • lesser tuberosity
  • anatomic neck
  • surgical neck

treatment: Sling and swathe for several weeks, ortho outpatient follow up in 3-5 days if

Shaft fracture

Consider abuse of <3 years old

Radial nerve palsy is common, resolved with treatment

treatment: Older kids/adolescents - Hanging long arm cast, ortho outpatient follow up in 3-5 days

Immediate ortho consult: Child >20° or adolescent >10° angulation and/or radial nerve injury


Supracondylar fracture

On XR - posterior and anterior fat pads, anterior humeral line (bisects mid 1/3 of capitellum)

Radial/median/ulnar palsies generally resolve with reduction

treatment: Minimally displaced: long arm posterior splint with elbow at 90° and forearm protonated/neutral

Ortho follow up in 3-5 days with immobilization for 3 weeks

Immediate ortho consult for more than minimal displacement or neurovascular compromise

Lateral condylar Displace >2 mm, requires ortho reduction
Medial epicondylar

Displaced: requires open reduction by ortho

Nondisplaced: posterior splint with forearm pronated

Radial head and neck

treatment: splint elbow 90° forearm pronated/neutrol, always follow up with ortho

Immediate ortho consult for angulation >15°

Elbow dislocation High risk of neurovascular injury, always consult ortho for reduction
Radial head subluxation

AKA 'nursemaid's elbow'

Child holds are pronated, slightly flexed

treatment: reduce with supination and flexion, post reduction patient uses arm in 5-10 minutes


Radius/ulna shaft

75% are distal third, isolated ulna very rare

treatment: <10° sugar-tong splint, immediately consult ortho for >10° angulation

Monteggia fracture

Ulna fracture and radial head dislocation

Always consult ortho immediately!

Galeazzi fracture

Radial shart disruption of distal radioulnar joint

Always consult ortho immediately!

Distal radius/ulna

Distal radius AKA Colles' fracture

treatment: Splint and ortho follow up in 3-5 days

  • Torus: Volar/short arm
  • Greenstick/complete: Long arm posterior or sugar-tong

Immediate ortho consult for angluation >10-15°

Carpal bones

Fractures are rare

If scaphoid injury even suspected, thumb spica/cast for at least 2 weeks


Metacarpal fracture

treatment: Distal 5th (boxer's) if nondisplaced apply gutter splint with MCP joint at 70°

Immediate ortho consult if >30-40° angulation; closed reduction often needed

Phalangeal finger dislocation

PIP/DIP - Reduce and buddy tape x3 weeks, if PIP consider digital block pre-reduction

MCP - If initial reduction fails. consult hand surgeon (plastics)

Refer gamekeeper's thump (avulsion of ulnar collateral ligament; requires thumb spica x3-6 weeks

Phalangeal finger fracture

Distal tuft crush injury - treatment: laceration closure

Most other fractures - treatment: buddy tape


Hip dislocation Closed reduction within 6 hours
SCFE 8-15yo M:F 2:1, associated with obesity, increased risk in blacks, patient complains of hip/knee pain
Femoral shaft fracture

Birth-2yo: Traction or immediate casting

2-10yo: Ortho consult, traction with spica casting

Adolescent: Stabilize with traction splint, consult ortho

Femoral neck fracture Traction/splint with ortho consult for closed or open reduction


Knee dislocation Immediate reduction recommended, arteriogram post reduction
Patella fracture

Non-dislocated: cylindrical cast x4-6 weeks

Displaced >3-4mm: ORIF

Patella dislocation Closed reduction with knee immobilizer x4 weeks


Proximal tibia fracture Early ortho consult especially if intra-articular
Tib/fib shaft Long leg posterior splint, ortho follow up in 3-5 days
Toddler's fracture

Technically an oblique non displaced fracture of the distal tibia

treatment: Posterior splint

Ankle & Foot

Distal tibia/fibula fractures

Non-displaced: bulky posterior splint and crutches with ortho follow up in 3-5 days

Tilaux: Salter III of distal tibia, requires ORIF

Mid/Hindfoot fractures

Talus: pain with dorsiflexion

Calcaneous: fall from a height

Midfoot fractures are rare

treatment: bulky posterior splint, crutches, ortho follow up in 3-5 days


Base of 5th metatarsal: 'Jones fracture', high nonunion rate

Non-displaced - bulky splint and crutches

Phalanged: buddy tape, hard soled shoes

Intra-articular: great toe and/or significant displacement requires pinning

See Also

  • Fractures


    • Cincinnati Children's Hospital "The Pocket" 2010-2011
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