Common Acute Upper Extremity Injuries In Sports

Pediatric Musculoskeletal Injuries

Musculoskeletal injuries are a common reason for emergency department and primary care visits in the pediatric population. The prevalence of these injuries is likely related to children and adolescents participating in sports activities, physical activity, and exercise that can lead to these injuries. It is important for health care professionals and practitioners to understand the assessment, evaluation, and treatment of musculoskeletal injuries, but also to understand when to refer for expert consultation. [Pediatr Ann. 2022;51(9):e330-337.].

Utility of a long arm extension cast in management of pediatric fractures: A technique revisited

A long arm cast with the elbow extended is a useful but often forgotten technique to manage some pediatric fractures. Specifically, proximal forearm fractures of both the radius and ulna, olecranon fractures, flexion-type supracondylar fractures and type II Monteggia fractures are well managed in this manner. Although some of these fractures are seen infrequently, timely diagnosis and treatment are essential to prevent complications. In this article, we present a review of the evaluation and management of these fractures in children, and a description of the technique used to apply a long arm cast in extension.

An unusual case of bilateral anterior shoulder dislocations

A 23-year-old man was transported to a trauma center after injuring himself while snowboarding. He presented with bilateral shoulder pain and associated deformity to both shoulders. His exam was otherwise unremarkable, and his x-rays confirmed bilateral shoulder dislocations. Cunningham and external rotation without sedation and analgesia techniques were unsuccessful even with local anesthesia to the joint. Subsequent bilateral reduction was successful with moderate sedation using the Milch technique. Simultaneous anterior bilateral shoulder dislocations are rare and providers may need to adjust their techniques to accommodate this unusual presentation.

Epidemiologic features and management of elbow dislocation with associated fracture in pediatric population

This study was conducted to explore epidemiologic features of traumatic elbow dislocation with associated fractures in pediatric population following appropriate treatment options.Incidence of elbow dislocation with associated fractures was analyzed in 67 children using elbow radiographs. Treatment for the displaced elbow joint was performed by closed reduction and proper immobilization. Surgical intervention was applied to restore the correct alignment of the fracture. Mayo Elbow Performance Score (MEPS) was used to measure elbow joint function.Incidence of pure dislocation was observed in 7 of 67 children (10.45%). Elbow dislocation was typically accompanied by a single or multiple fractures in 39 (58.21%) and 21 (31.34%) of 67 children, respectively. In contrast, lateral humeral condyle fracture and medial humeral epicondyle fracture accounted for 35.90% and 30.77% of pediatric elbow fractures. All children with elbow fracture-dislocations received surgical intervention by open reduction and internal fixation. During follow-up, 56% to 92% of children displayed significant recovery of elbow function with improving MEPS after the displaced elbow and fractured fragments were reduced and held in place for weeks. There were statistical differences in MEPS between the types of fractures (P < .05 or P < .01).Incidence of isolated elbow dislocation without fracture is low; rather, it is frequently associated with fractures. Early surgical intervention achieves stable fixation and bony union with utility in improving elbow function in the pediatric population.

The Factors Influencing the Refracture of Pediatric Forearms

PURPOSE

Pediatric forearm fractures are common and usually heal uneventfully. The purpose of this study was to review the refracture rate and to identify trends and risk factors that may lead to a refracture.

METHODS

Using current procedure terminology code and subsequent chart review we retrospectively identified 2590 patients who sustained forearm fractures over the past 10 years (2000 to 2010) and were treated at a single, large pediatric orthopaedic practice.

RESULTS

We identified 37 patients who met our search criterion which yielded a refracture rate of 1.4%. Average length of immobilization was 72.2 days for initial fractures and 98.2 days for refractures. Average time to refracture after declared healing of initial injury was 128.7 days with 36% of refractures occurring within 6 weeks of clinical clearance. Fractures with ≥ 15 degrees angulation refractured earlier (mean 40 d). Seventy-one percent (71%) of patients with refractures had ≥ 10 degrees residual angulation at the time of union of the initial fracture. There was complete radiographic healing in 72% of patients that subsequently refractured. Forearm fractures that refractured most commonly occurred in the middle third (72%), with 24% in the proximal third and 4% in the distal third. Only 2 of 28 patients required surgical instrumentation of the forearm to achieve union of the refracture. We identified a trend toward longer immobilization and time to clinical clearance following a refracture, 76.4 versus 104.2 days.

CONCLUSIONS

Over the past 10 years, our clinical data identifies a 1.4% refracture rate, which is significantly less than the previously published rate of 5%. Fractures with greater residual angulation (> 15 degrees) showed a tendency toward earlier refracture and may warrant longer immobilization. Forearm refractures united in most instances with closed treatment. Our treatment with cast or protective brace immobilization and limitation of activity until complete radiographic union likely influences our improved refracture rates.

Upper extremity injuries in Danish children aged 6-12, mechanisms, and risk factors

Although injuries to the upper extremity are most costly, the picture of the upper extremity injury problem remains incomplete. This study is the first to describe the etiology and mechanisms of upper extremity injuries in Danish children. A 2.5-year observational prospective cohort study was conducted to record upper extremity injuries in 1048 children. Data were weekly collected by sending a text message. A total of 176 upper extremity injuries were reported (128 acute injuries). Of the acute upper extremity injuries, 55% were sprains, 47% occurred in the hand/wrist, and 53% of cases were caused by a fall. When corrected for exposure to physical activity, this resulted in an acute upper extremity injury incidence density of 0.18 per 1000 h of physical activity. The odds of sustaining an upper extremity injury was higher in the older children (HR: 1.84, 95% CI: 1.10-3.09), a tendency was found suggesting that girls are at increased acute upper extremity risk compared to boys (HR: 1.40 95% CI: 0.97-2.04). The findings that most injuries occur after a fall, that injury risk increases over age and that girls seem to be at increased injury risk provides essential information to guide future childhood injury prevention.

In-game Management of Common Joint Dislocations

Context:

Sideline management of sports-related joint dislocations often places the treating medical professional in a challenging position. These injuries frequently require prompt evaluation, diagnosis, reduction, and postreduction management before they can be evaluated at a medical facility. Our objective is to review the mechanism, evaluation, reduction, and postreduction management of sports-related dislocations to the shoulder, elbow, finger, knee, patella, and ankle joints.

Evidence Acquisition:

A literature review was performed using the PubMed database to evaluate previous and current publications focused on joint dislocations. This review focused on articles published between 1980 and 2013.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

The clinician should weigh the benefits and risks of on-field reduction based on their knowledge of the injury and the presence of associated injuries.

Conclusion:

When properly evaluated and diagnosed, most sports-related dislocations can be reduced and initially managed at the game.

Pediatric upper-extremity fractures

Upper-extremity fractures account for more than half of childhood bony injuries. The frequency of injury increases with increasing mobility. The most common mechanism is a fall on an outstretched hand while playing. Optimal management requires knowledge of the normal anatomy and variants unique to pediatric bones. The physician needs to maintain a high level of suspicion for growth plate injuries because if unrecognized, these may result in growth arrest. Although the vast majority of pediatric upper-extremity fractures will heal rapidly with minimal intervention, physicians should be aware of the complications that can arise from these injuries.

The emergent evaluation and treatment of hand and wrist injuries

The anatomy of the hand is complex, which allows for the dexterity, strength, and adaptability of the most functional aspect of the musculoskeletal system. The evaluation and management of injuries to this area can be time consuming and pose a significant medicolegal risk to the emergency physician. Improperly diagnosed and managed injuries can lead to chronic pain, inability to perform activities of daily living, and even seemingly minor injuries can lead to missed work causing a significant cost to the individual and society. The purpose of this article is to review injuries to the hand and wrist and discuss diagnostic studies and treatment plans that the emergency physician can use to treat patients effectively and minimize their exposure to risk.