Pediatric emergency medicine trisk 3471 3471
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than 30 degrees of angulation should be immobilized in an above-the-elbow cast
at 90 degrees of flexion. Greater degrees of angulation require closed reduction.
FIGURE 111.23 Buckle fracture of the radial neck in a 9-year-old girl (arrow ). Wrist pain was
the chief complaint. The treating physician failed to identify the proximal radial fracture, which
was, however, noticed by the radiologist.
Radial head fractures, by contrast, are less common before skeletal maturity.
When they occur, there is risk of progressive subluxation, requiring orthopedic
follow-up. Operative treatment is considered for displacement over 2 mm,
articular fragmentation, and comminution. The incidence of complications,
especially loss of motion and overgrowth of the radial head, is significant, making
orthopedic referral advisable for all radial head and neck fractures. Injured
children with minimally displaced or nondisplaced fractures should have the
elbow immobilized in the ED and referred for outpatient orthopedic follow-up.
Elbow Dislocations
CLINICAL PEARLS AND PITFALLS
Fractures most commonly associated with elbow dislocation include
fractures of the medial epicondyle, coronoid process, olecranon, and
proximal radius.
Posterior dislocations of the elbow must be carefully examined for
neurovascular injury, with particular attention to possible median nerve
entrapment, and injuries to the ulnar nerve or brachial artery. Nerve
injury is more common than vascular injury.
True arterial rupture is seen almost exclusively with open dislocations
but has been described on occasion with closed injuries.
