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

Points & Pearls Excerpt

• The compliance of children’s bones results in unique injury patterns, including plastic deformation, greenstick fractures, and torus fractures.
• When initial evaluation for fracture is uncertain, recommend follow-up to obtain repeat radiographs, as it may take 1 to 2 weeks to see callus formation in children.
• Approximately 30% of physeal fractures result in premature closure of the growth plate, asymmetric growth, and subsequent deformity. Use the Salter-Harris classification system to describe physeal fractures (the risk of growth disturbance increases from type I to type V).
• The presence of several ossification centers in the pediatric elbow makes radiographic detection of fractures more difficult. The CRITOE mnemonic (capitellum, radial head, internal or medial epi-condyle, trochlea, olecranon, external or lateral epicondyle) may be useful in recalling the order of radiographic appearance of ossification sites.