🦴 Section 724.3 · Upper Extremity Fractures

Nelson Textbook of Pediatrics 22nd Edition | Phalangeal fractures: Seymour fracture (open physeal, nail matrix interposition), mallet finger (avulsion of terminal tendon). Scaphoid fracture: tenderness in anatomic snuffbox, may need MRI. Forearm fractures: torus (buckle, stable), greenstick (unicortical, may need reduction), diaphyseal (risk of malrotation → loss of pronation/supination). Monteggia (ulna + radial head dislocation), Galeazzi (radius + DRUJ disruption). Supracondylar humerus: most common elbow fracture, type III requires emergent closed reduction + pinning, check median nerve (AION) and brachial artery. Lateral condyle fracture: intra-articular, needs anatomic reduction (open if displaced >2mm). Proximal humerus: excellent remodeling (80% growth from proximal physis), sling for most.

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📋 30 Clinical Scenarios — Upper Extremity Fractures

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🩺 Clinical Recognition: Upper Extremity Fractures

Select a presentation to review diagnostic clues and management per Nelson 724.3.

📋 Stepwise Management of Upper Extremity Fractures

🔑 Key Principles — Nelson Section 724.3
• Supracondylar humerus: Most common elbow fracture (age 3-10). Type III (displaced) → emergent closed reduction + percutaneous pinning. Check for median nerve (AION — OK sign) and brachial artery injury.
• Lateral condyle fracture: Intra-articular, SH IV. Displaced >2mm → open reduction internal fixation (ORIF). Nonunion risk.
• Forearm fractures: Torus (stable, splint). Greenstick (may need reduction). Diaphyseal (risk malrotation → loss of pronation/supination). Monteggia: reduce ulna to reduce radial head.
• Proximal humerus: Excellent remodeling (80% growth). Sling for most. Surgery if >50° angulation in older child.
• Scaphoid: Anatomic snuffbox tenderness. MRI if normal X-ray but high suspicion.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Upper Extremity Fractures (Nelson 724.3)