Fracture of the clavicle

Can occur after a fall on an outstretched arm (more likely to cause a Colles’ fracture in the old). Collar and cuff sling for 3 weeks, internal fixation only if there is non-union. Beware neurovascular injury and pneumothorax.

Supracondylar fracture

Fracture of the distal humerus, just above the condyles, this is a virtually paediatric only fracture. Falling on an outstretched hand with an extended elbow is the usual mechanism. Brachial artery injury common, avoid flexing elbow. Sail sign due to displaced fat pads on x-ray suggests diagnosis. Internal fixation provides best results.

Pulled elbow

Common in young children, usual scenario is a child that has been lifted by the arms. Can be treated in A + E with forced supination of the forearm producing a click and reducing the radial head back into place. Rest joint for 2 days afterwards advised.

Monteggia fracture

Fracture to the proximal third of the ulnar caused by forced pronation. Can be managed with closed or open reduction and 5 weeks in plaster.

Galeazzi fracture

Fracture of the distal third of the radius. Can be treated with closed reduction although open may be needed.

Spiral fracture of the distal tibia

Common known as a toddler’s fracture, can occur in simple, ground level falls. Child will likely limp or refuse to bear weight. Treatment is long leg casting for 5 to 6 weeks.

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