General Principles of Pediatric Fracture Care
While a fracture or dislocation in a child is often easily diagnosed with a simple clinical evaluation and a radiograph, a stepwise approach is useful to establish a diagnosis in cases that are not so obvious. The evaluation includes a detailed history, comprehenasive physical examination, and only then a review of imaging studies. It is useful to ask a parent to assist you, by talking them through parts of the examination. Remember that some fractures will not appear on a radiograph for 10–14 days, so if the diagnosis is unclear, it is useful to splint or cast the affected area for 10–14 days, after which the immobilization is removed and the clinical exam and radiograph repeated. General guidelines for accpetable alignment have been published and depend upon remodelling potential which in relates to the plane of motion, proximity to neighboring joints or growth centers, and also the amount of growth remaining. Growth plate (physeal) fractures must be reduced promptly, and many are at risk for growth disturbance therefore requiring close followup. Managing fractures and dislocations which present in a delayed fashion is a challenge and may result in suboptimal outcomes.
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