Pediatric emergency medicine trisk 3458 3458
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FIGURE 111.18 Common elbow fractures in children: lateral condylar fracture (A ), medial
epicondylar fracture (B ), and radial neck fracture (C ).
The treatment of acute, nondisplaced fractures (e.g., Gartland type I) or when
only the posterior fat pad sign is present is generally nonsurgical immobilization.
These injuries should be splinted in a long arm posterior splint/back slab, with the
arm in pronation or neutral rotation and at 90 degrees of flexion at the elbow.
Children should be referred to orthopedics for casting within 1 week if not casted
at the initial encounter in the ED. Immobilization for a total of 3 to 4 weeks is
often sufficient. Supracondylar injuries have minimal potential for remodeling;
therefore, displaced fractures (Gartland type II and III) without neurovascular
injury should have urgent orthopedic consultation for reduction ( Fig. 111.19 ).
Reduction is performed to decrease the risk of cosmetic deformity or poor
functional outcomes (e.g., Volkmann contracture or cubitus varus). Current
American Academy of Orthopedic Surgeons consensus recommends reduction
and operative repair of all type II fractures, however it may be acceptable for
minimally displaced type II to be treated nonoperatively. Whether or not surgery
is indicated, some type II injuries may be considered for outpatient referral for
definitive treatment. For injuries without neurovascular compromise, existing
