Thread by @NSLIJ_EM

#EMConf with @bryanmccartymd on Peds Ortho:

Kids bend, they don't snap.
Bends that stay bent without cortex breaking is called plastic deformation.

These still get splinted and do great, but still need reduction if >20⁰ bent.

When one side breaks and the other (near) side bends, that's a greenstick.

Periosteum torn on only one side, splint/reduce, maybe under sedation.

Torus/buckle is axial load, both cortices bent, typically no cast, removeable splint, may not need ortho F/U!
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Both bones? Forearm w both cortices involved, even if one is greenstick or plastic deformity: less stable, procedural sedation and reduction.

Poss. OR when the reduction isn't stable.
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Supracondylar fracture!

Peds elbows are typically these. Post fat pad = hematoma = fx.

Respect the neurovascular complications, document pulses:

Brachial artery and radial n. involvement can lead to wrist drop or ischemic limb.
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CRITOE!

6 growth plates in elbow, i order of ossification-
Capitellum
Radial head
Inner epicondyle
Trochlea
Olecranon
External epicondyle

Look it up, but remember, it's about what you SHOULDN'T be seeing at that age- in a 5yo, that thing that looks like olecranon? It's a fx.

Lines of interest in the elbow Xray-

Anterior humeral line should go thru mid third of capitellum.

It's pushed forward to ant. 1/3 or doesn't hit capitellum?

That's a supracondylar fx.
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Nursemaid's!

Every EM doc's fave, a subluxation where annular ligament trapped btw rad head and capitellum.

Tx with hyperpronation/extension to supination/flexion maneuver.
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