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Upper-extremity impairment in young children

S A Schutzman1, S Teach

  • 1Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts, USA.

Annals of Emergency Medicine
|October 1, 1995
PubMed
Summary

Most young children with upper extremity immobility have radial head subluxation (RHS) or fractures. Clinical findings can help differentiate diagnoses, but rare non-trauma causes like infection should be considered in infants.

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Area of Science:

  • Pediatric Emergency Medicine
  • Orthopedic Surgery
  • Pediatric Traumatology

Background:

  • Upper extremity injuries are common in young children.
  • Accurate diagnosis is crucial for appropriate management and to avoid complications.

Purpose of the Study:

  • To determine the spectrum of pediatric upper extremity disorders in children under 6 years.
  • To identify clinical findings associated with specific diagnoses.

Main Methods:

  • Prospective observational study in a pediatric emergency department.
  • Inclusion of children under 6 years with upper extremity injury or immobility over a 6-month period.
  • Analysis of diagnoses and clinical findings.

Main Results:

  • 178 episodes evaluated; Radial Head Subluxation (RHS) was most common (63%), followed by fractures (22%) and soft-tissue injuries (13%).
  • Younger children (<4 months) with immobility were more likely to have infection or neurologic impairment.
  • Clinical signs like point tenderness and swelling correlated with fractures, while decreased arm movement and a "pull" mechanism suggested RHS.

Conclusions:

  • Bony or soft-tissue trauma, primarily RHS, accounts for most pediatric upper extremity injuries.
  • Clinical assessment aids in differentiating RHS from fractures, guiding decisions on reduction or radiography.
  • Non-trauma diagnoses are rare but important considerations, especially in infants; appropriate immobilization and follow-up are key for unclear cases.

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