Document the neurovascular status of the limb. A fractured limb should
be splinted for comfort and protection before transfer.
Joint dislocation reduce and splint
Supracondylar elbow fracture immediate surgery
Open fractures immediate surgery
Femoral neck fractures immediate surgery
Include the joint above and below the fracture to avoid missing an associated
Pediatric patients often are unable to localize pain; another reason for imaging joints
above and below area of concern.
X-rays should be taken in two planes; i.e. AP and lateral.
When diagnosing epiphyseal separation or fractures of unossified epiphyses, obtain
comparison limb views.
A childs healing and remodeling capabilities can compensate for imperfect
alignment to a much greater degree than an adult.
Rapid fracture healing: femur fracture in infant - 3 weeks; 8 year old - 8 weeks.
To prevent physical injury, growth plate fractures should be reduced only once. Splint
and refer to an orthopedist on an urgent basis.
Rotational malalignment and lateral angulation do not self correct. Bayonet apposition
and anteroposterior angulation in place of joint motion do tend to correct.
Open fracture use advanced trauma life support (ATLS) guidelines.
Be aware of child abuse. If the story does not fit the injury, consider doing entire
long bone/body x-rays if child abuse is suspected.
Growth disturbances after epiphyseal plate injuries.
Volkmann's ischemia of nerves and muscles.
Post-traumatic myositis ossificans.
Reviewed by CDR Wendy Bailey, MC, USN, Pediatric Specialty Leader, Naval Medical
Center San Diego, San Diego, CA (1999).
· Administrative Section
· Clinical Section
General Medical Officer Manual , NAVMEDPUB 5134, January 1, 2000
of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C.,
web version of The General Medical Officer Manual, NAVMEDPUB 5134 is provided by
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