Other Injuries

Other paediatric injuries can be managed in the following ways:

Lateral epicondyle epiphyseal injury

Undisplaced fractures can be managed in a back slab with orthopaedic follow up.

Displaced fractures often need reduction.

Fig. 14: Lateral epicondyle avulsion

Medial epicondyle avulsion injury

Undisplaced avulsions can be managed conservatively.

Displaced fragments should be referred for reduction.

Radial neck fracture

Treatment is similar to that for radial head fractures:

• Undisplaced fractures can be managed with a collar and cuff sling and orthopaedic outpatient follow-up
• Comminuted or displaced fractures may require manipulation under anaesthetic or internal fixation

Orthopaedic referral is recommended if there is greater than 30^o of angulation.

Pulled elbow

The x-ray would appear normal and is therefore not necessary prior to attempted manipulation if clinical suspicion is high.

Traditional reduction is achieved by flexing the elbow to 90^o and then fully supinating or pronating the forearm, there may often be an associated click and the child will begin using the arm a short time later.

Learning bite

A pulled elbow can be quickly and easily treated in the emergency department with passive supination/pronation of the forearm.