Pediatric emergency medicine trisk 3483 3483
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Greenstick fractures . Greenstick fractures of the forearm, like complete fractures,
have a tendency to displace if not properly immobilized. The distal fragment is
angulated posteriorly in most greenstick and complete fractures of the distal
forearm. Angulation of greater than 10 to 15 degrees is an indication for urgent
orthopedic referral. When there is no significant angulation or displacement of
greenstick and complete radial and ulnar fractures, immobilization in a neutral
position with either a long arm posterior splint or a sugar-tong splint with
orthopedic follow-up within 3 to 5 days is adequate emergency management.
Salter–Harris fractures . Salter–Harris types I and II injuries of the distal radial
physis are common injuries among children 6 to 12 years old, and rarely lead to
growth disturbance. The risk of growth disturbance increases with repeated and
delayed manipulations. Clinicians should be prepared to make the presumptive
diagnosis of a Salter–Harris type I injury when there is point tenderness on the
physical examination corresponding to swelling over the distal radius on the
radiograph, even when there is no obvious displacement of the epiphysis.
Orthopedic consultation for closed reduction is indicated for all displaced and
angulated physeal fractures, while immobilization and orthopedic referral are
recommended for nondisplaced fractures of this type.
