Pediatric shoulder, upper arm, and elbow trauma

The evaluation of upper extremity trauma in children requires careful history taking to identify the mechanism and energy of injury. During the physical examination of an injured child, particular attention should be paid to the pretreatment neurovascular assessment so that any intraoperative or postoperative changes can be identified. Radiographic assessment should target the zone of injury and adjacent joints and long bones. Several fracture patterns can be visualized optimally with specific radiographic views. An understanding of the natural history of nonsurgically treated fractures and their long-term functional outcomes will improve surgical decision making. Clinical practice guidelines and appropriate use criteria recently have been developed by the American Academy of Orthopaedic Surgeons to aid in the management of all pediatric supracondylar humerus fractures and in those supracondylar humerus fractures associated with vascular injury.