Accurate Reporting of Pediatric Fractures
A Guide for Orthopedic Consultation
Kapi’olani Medical Center For Women And Children’s Emergency Department
Children's Orthopaedics of Hawaii, LLC
Accurate description of the fracture Displaced lateral condyle fracture Avoid giving predictions to the family about
(radial side; capitellum) are intra-articular injuries
is the most important factor in determining the need for since they involve the joint surface. These
what the orthopedic management will be once
immediate orthopedic care. In describing the fracture to commonly require surgery if displaced, but the the orthopedist is involved. Delayed surgical
urgency of the orthopedic referral is based on the intervention or delayed casting is sometimes
the orthopedic surgeon, please include the following: patient’s neurovascular status.
Site of injury: Which bone(s) are affected? the preferred management option. Parents
What part is broken? Proximal / Midshaft / Distal may be unhappy with this if they are initially
Fracture pattern: Transverse (broken straight across) led to expect immediate intervention.
Oblique (slanted or diagonal break)
Spiral (“twisted” break) Splinting an extremity is an easy office skill
Comminuted (shattered) Non-displaced Early casting may have a higher complication rate
Angulation present? (i.e. Is the fracture bent?) lateral condyle compared to later casting. Splinting provides excellent initial
Degrees and direction of angulation. care until orthopedic surgery can see the patient.
Displacement present? (i.e. Has the fracture shifted?)
1. Obtain splinting material such as
Approximate percentage of displacement.
plaster, Ortho-glass, Scotchcast, Sam
Is any shortening present? How much? Medial epicondyle fracture: Partially displaced medial (ulnar side) epicondyle
splint, or even an IV board.
Is this fracture open? (skin intact over the fracture) fracture. This is not as serious and can be placed in a splint and referred to
orthopedics electively. 2. Cut an appropriate length of
Neurovascular status intact? splinting material.
Distal radius fracture. 3. Pull out the padding to cover
Buckle (or torus) type.
the sharp edges of the fiberglass.
Minimal angulation. This
can be placed in a volar
splint and sling. Non-urgent
referral to orthopedic
Angulated edges edges
25 degrees, apex Supracondylar Fractures exposed covered by
points to the left padding
1 cm Type I
(non-displaced) 4. Lay the fiberglass out and apply
Shortened valgus angular
Displaced by 1 cm 25 degrees AND
50% to the right Displaced 80%
a posterior elbow
splint, sling, and
5. Then roll it in a dry towel to
Type II supracondylar remove moisture.
Mid-ulna fracture. Approximately 20 degrees angulation. The apex is AP view shows valgus Optional: You could wrap the
pointing toward the volar side (confirm the apex clinically). No angulation (5 degrees). extremity in cast padding or any
displacement. Radial head [R] is dislocated (it should be aligned with Lateral view shows the
the capitellum [C]). Ulna fractures are frequently associated with radial apex of the angulation
fluffy material for extra padding.
head dislocation (the Monteggia injury). (30 degrees) pointing However, Ortho-glass and
anteriorly. Scotchcast come pre-wrapped in
Type III supracondylar fractures are 6. Here is an example
worse, showing greater degrees of valgus of a simple volar forearm
deformity and a higher risk for neurovascular splint. Hold the splinting
Non-displaced, spiral fracture compromise. material on the volar surface
of the mid-femur. This view of the forearm rolling the
shows minimal angulation.
distal end in the palm.
7. Roll an elastic
wrap over the
resemble fracture forearm and splint.
fragments. This X-ray The splint material
Other views are needed to
determine angulation in other shows all the will mold to fit the
planes. ossification centers extremity nicely.
in the elbow which
ossify in the sequence
(R) radial head
Comminuted (I) internal epicondyle
(shattered, multiple (T) trochlea
fragments) of the
distal tibia. No
Other splint types: Apply splint material, then roll an elastic bandage
Salter-Harris fractures over this. The splint material will mold nicely to fit the extremity.
involve the physis (growth
Transverse fracture of plate) of long bones. Types
the distal radius which 1, 2, 3, 4, 5 are diagramed
is 100% displaced, here. Since the physis is
shortened (over- not ossified, a fracture
riding) approximately through the physis cannot
2 cm, and angulated Rad be visualized on X-ray
with the apex of the easily.
toward the ulnar side
of the forearm. The Non-displaced distal ulna fracture with 20
distal ulna is fractured degrees of angulation. The apex of the
in two places. The angulation points toward the radial side of
epiphysis of the ulna
(arrow) is displaced Ulna the forearm. Salter-Harris type II fracture
of the distal radius involving the Volar forearm splint
(behind the radius on the lateral view). There is also a “greenstick” metaphysis into the physis. There is a Posterior elbow splint
fracture of the distal 1/4th of the ulna which is angulated slight degree of angulation with the apex Sugar tong elbow splint
approximately 20 degrees with the apex pointing toward the ulnar and point toward the radial side of the
dorsal sides of the forearm. Posterior short leg ankle splint
Stirrup or sugar tong ankle splint
For more fracture images, info, and downloadable copies of this poster, visit: www.hawaii.edu/medicine/pediatrics