![]() A prospective study comparing ED splinting and casting for pediatric wrist buckle fractures is needed. Splinting in the ED with primary care follow-up appears to be a reasonable management strategy for these fractures. ED casting may pose more risk than benefit for these children. Orthopedic follow-up visits and radiographic follow-up may have minimal utility in the treatment of pediatric wrist buckle fractures. No subjects had fracture displacement identified on follow-up. Of the 276 subjects who had orthopedic follow-up visits and radiographs, 184 (67%) had multiple visits and 127 (46%) had multiple radiographs performed. Emergency physicians immobilized 269 of these fractures in circumferential casts of these, 30 (11%) had cast complications. The median age of our study cohort was 9.2 years. Of these, 309 met our inclusion criteria. We identified 840 children with fractures of the wrist, radius, or ulna. We excluded children who had other types of fractures. Based on the radiology reports, we identified buckle fractures of the distal radius, the distal ulna, or both bones. Usually a player can resume training in the cast after about a week, but the cast needs to be padded for soccer matches. This injury is treated with a short arm cast for about a month. We performed a retrospective medical record review of all children < 18 years of age who presented to our tertiary care children's hospital between July 1, 2000, and June 30, 2001, and were diagnosed with a fracture of the wrist, radius or ulna. The most common fracture is the green stick or buckle fracture at the end of the radius bone near the wrist. Those cases are more impressive, and it is more intuitive that those fractures have a tendency to shift back to their pre-reduction position and should be molded in the opposite direction to prevent that possible shift.The objective of this study was to evaluate the utility of circumferential casting in the emergency department (ED), orthopedic follow-up visits, and radiographic follow-up in the management of children with wrist buckle fractures. Some kids with distal radius fractures need a reduction (not covered in this article). Unstable fractures have a tendency to shift. A simple dorsal buckle fracture of the distal radius is a good example (as in Case 2). They need comfort and protection while healing. Stable fractures will not shift with activities of daily living. Distal radius fractures are the most common.įractures can be stable or unstable. Each is mildly swollen and tender at the distal radius, closed, neurovascularly intact, and without scaphoid (or other carpal) tenderness. If you see kids in your emergency department, then you’re managing pediatric fractures. ACEP Now: Vol 36 No 10 October 2017 The Cases Here are X-rays of four pediatric patients with isolated wrist injuries after a fall. Make sure you see the X-rays, not just the report! Don’t solely rely on the radiologist’s report.Volar buckle fractures are less common, more difficult for emergency physicians to appreciate, and more likely to be mismanaged these should be molded in extension.For these fractures, the distal fragment tends to shift dorsally the fractures should be molded in flexion. If the dorsal buckle fracture extends to the volar side or if the distal fragment is dorsally angulated, then it is not a simple dorsal buckle fracture. ![]() Transverse fractures (also called complete or bicortical fractures) can be subtle on X-ray.Simple dorsal buckle fractures are stable.The Clinical Pearls: Pediatric Distal Radius Fractures Optimal ED management requires us to recognize the subtle differences between these pediatric distal radius fractures. However, two of the cases should be molded in flexion the third case, in extension. For the other three cases, they require well-molded immobilization in the emergency department. Of the above four cases, the radiology report for each may read, “buckle fracture of the distal radius.” One case is a simple buckle fracture, and it tends to be overtreated in the emergency department. What is your diagnosis, emergency department treatment, and follow-up plan for each? Here are X-rays of four pediatric patients with isolated wrist injuries after a fall. Tips for Diagnosing Occult Fractures in the Emergency DepartmentĮxplore This Issue ACEP Now: Vol 36 – No 10 – October 2017 The Cases.Pearls from Emergency Medicine Literature on Pulmonary Problems, Bleeding, Evaluating Pediatric Injuries, and More.Tips for Catching Commonly Missed Ankle Injuries.
0 Comments
Leave a Reply. |