This AAOS instructional course lecture by Scherl and Schmidt addresses emergency management of pediatric fractures that are either unique to children or managed differently than in adults. It covers supracondylar humeral fractures, elbow fractures, hip fractures and dislocations, and physeal fractures about the knee. The article provides classification frameworks, surgical timing thresholds, and complication profiles for the on-call orthopedic provider.
Every orthopedic resident on trauma call will face these injuries in children, often without a pediatric subspecialist available.
For supracondylar fractures: a normal neurovascular exam allows you to defer surgery to the next morning safely, but the 22-hour threshold is a real ceiling — do not let these cases drift to afternoon. For any child with a pulseless hand after reduction, the "pink pulseless hand" remains a management controversy; the standard recommendation is observation rather than immediate vascular exploration.
For pediatric hip fractures: the osteonecrosis risk is sobering and in large part predetermined by how proximal the fracture is. Tell the family up front. Do not compromise fixation stability to protect the physis. Cross it with pins if necessary, because the proximal femoral physis contributes only 3 mm of growth per year and any resulting leg-length discrepancy is manageable.
For hip dislocations: the 6-hour reduction window is the actionable number. Use general anesthesia and muscle relaxation. Reduction attempts in the ED under sedation risk creating a transphyseal fracture of the femoral head, as illustrated in the article's case figures.
This AAOS instructional course lecture by Scherl and Schmidt addresses emergency management of pediatric fractures that are either unique to children or managed differently than in adults. It covers supracondylar humeral fractures, elbow fractures, hip fractures and dislocations, and physeal fractures about the knee. The article provides classification frameworks, surgical timing thresholds, and complication profiles for the on-call orthopedic provider.
Every orthopedic resident on trauma call will face these injuries in children, often without a pediatric subspecialist available.
For supracondylar fractures: a normal neurovascular exam allows you to defer surgery to the next morning safely, but the 22-hour threshold is a real ceiling — do not let these cases drift to afternoon. For any child with a pulseless hand after reduction, the "pink pulseless hand" remains a management controversy; the standard recommendation is observation rather than immediate vascular exploration.
For pediatric hip fractures: the osteonecrosis risk is sobering and in large part predetermined by how proximal the fracture is. Tell the family up front. Do not compromise fixation stability to protect the physis. Cross it with pins if necessary, because the proximal femoral physis contributes only 3 mm of growth per year and any resulting leg-length discrepancy is manageable.
For hip dislocations: the 6-hour reduction window is the actionable number. Use general anesthesia and muscle relaxation. Reduction attempts in the ED under sedation risk creating a transphyseal fracture of the femoral head, as illustrated in the article's case figures.