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Plymouth Paediatric Orthopaedics

Upper Limb

The commonest site for children’s fractures is the wrist. Most are treated with a plaster, however those involving the growth plate or those that are severe, may require surgery. For those requiring surgery, the fracture is usually first manipulated under anaesthetic (MUA) with x-ray guidance. If it is stable a plaster is applied. If the fracture is unstable, wires may be inserted into the bone to provide additional temporary support whilst the fracture heals. The wires are removed at around 3 weeks.

The forearm is a common site for children’s fractures. Most forearm fractures can be treated with a plaster. If an operation is indicated, an MUA is often all that is required. Unstable forearm fractures or ones that can’t be reduced by closed manipulation will require an open surgical procedure. Flexible metal rods can be inserted inside the bone to stabilise the fracture whilst it heals. Some fractures require the use of small metal plates and screws to fix them.

The elbow is a less common site for children’s fractures although of great importance due to the proximity of major nerves and blood vessels. Although rarely injured, these structures are at risk of damage when a fracture occurs. Fractures involving the elbow joint can occasionally be difficult to diagnose, as a child’s elbow is largely made of cartilage, so doesn’t show up as clearly on x-ray. Supra-condylar fractures occur just above the elbow. Very little displacement can be accepted with these fractures, and operative intervention is often required - an MUA followed by the insertion of 2 or more temporary wires. Lateral condyle fractures (outside of the elbow) also require accurate reduction to allow the elbow to grow normally. Medial epicondyle fractures (inside of the elbow) however rarely need operative intervention.

Very few fractures of the clavicle, shoulder or humerus in children require surgery. They usually require a brief period of immobilisation in a broad arm sling or collar and cuff.

Clavicle fracture