Pediatric Orthopedic Injuries: Evidence-Based Management in the Urgent Care (Trauma CME and Pain Management CME)

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Delivery Method:	Online
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Publication Date: September 2023 (Volume 2, Number 9)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 09/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma and .25 Pain Management CME credits, subject to your state and institutional requirements.

Authors

Peer Reviewers

Charting & Coding Author

Abstract

Upper and lower extremity injuries are common in children. Pediatric bone anatomy and physiology produce age-specific injury patterns and conditions that are unique to children, which can make accurate diagnosis difficult for urgent care clinicians. This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities. Evidence-based recommendations for management of pediatric fractures, including appropriate diagnostic studies and treatment, are also discussed.

Case Presentations

A 12-year-old boy presents to urgent care with 1 week of progressively worsening right hip pain...

• He has no fever or history of trauma. He saw his primary care pediatrician earlier in the week and was diagnosed with a hip strain, but his pain has continued to worsen.
• He is now unable to bear weight on the right leg.
• Physical examination reveals a well-appearing obese boy with no tenderness to palpation about the hip joint, femur, or knee, but markedly decreased internal rotation of the right hip.
• Neurovascular examination of the right lower extremity is normal.
• You wonder: What is the most likely cause of this child’s pain? What imaging studies will be most useful for diagnosis and management? Should this child be allowed to continue bearing weight? Does he need an urgent orthopedic consultation?

A 3-year-old girl is brought to the clinic after a fall onto her outstretched left hand...

• The patient's mother reports that the girl is using the left arm much less than usual.
• Physical examination reveals minimal swelling at the elbow. She flinches with palpation over any part of the elbow but has no tenderness over the distal forearm or shoulder. She can move her thumb and fingers spontaneously.
• Radiographs of the left elbow show no fracture.
• You wonder if this girl could possibly have a supracondylar humerus fracture. Should you be looking for something else on these radiographs? Do you need to get additional radiographs?

A 3-month-old boy is brought to the urgent care by his mother, who states that he seems to be moving his right arm less than usual today…

• The physical examination reveals a happy, interactive child with slightly decreased spontaneous movement of the right arm, but no apparent point tenderness to palpation along the extremity or shoulder.
• Grip strength in the right hand is normal. No bruises are noted.
• You try to obtain further history regarding a possible mechanism of injury, but the mother states she does not know of any traumatic incidents.
• What other questions should you ask? How concerned should you be about a possible fracture? You begin to think about nonaccidental injury. If you find a fracture in this child, what additional workup would be appropriate?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.