Pediatric musculoskeletal trauma

Clinical research within the past year has helped to improve understanding of children's fractures. Elevation of the posterior fat pad of the elbow is highly suggestive of fracture. Radial head dislocation should be carefully searched for on follow-up films after forearm trauma. Reduction and reconstruction may be successful up to 7 years after dislocation. Reabsorbable suture may replace wire for tension band fixation of olecranon fractures. An external fixator ideally should not be removed from a fractured femur before callus is seen bridging at least three cortices, and femur fractures treated by a plate should be shielded from full weight-bearing until healed. Open femur fractures have a 10% risk of ipsilateral leg compartment syndrome. Child abuse was found in 42% of femur fractures before walking age, and in 18% of humerus fractures before age 3. Operative treatment is more advantageous in most long-bone injuries in multiply-injured children than in isolated injuries.