Pediatric emergency medicine trisk 3449 3449

fracture displacement. Notably, a spiral fracture in a child less than 3 years old
may be suspicious for nonaccidental trauma unless the mechanism is consistent
with this pattern of injury ( Fig. 111.14 ). Vascular injuries are uncommon, but
there is risk of radial nerve injury in up to 5% of fractures, particularly for
fractures involving the middle and distal thirds of the humeral shaft. Fortunately,
most injuries of the radial nerve represent neuropraxias, and full return of
function may be expected within 3 to 4 months.
Nonoperative management is standard for uncomplicated diaphyseal fractures,
using the same techniques described above for proximal humerus fractures.
Alternatively, the application of a sugar-tong splint to the upper arm with a sling
to support the forearm is recommended for displaced fractures. Some orthopedic
surgeons advise reducing the angulation to less than 10 degrees before proceeding
with nonoperative treatment, but this recommendation is not universal as gravity
will help align the fracture over time. Indications for surgical stabilization and/or
urgent orthopedic consultation for isolated humeral shaft fractures include open
fractures, neurovascular compromise after reduction, completely displaced
fractures, or fractures angulated more than 20 degrees in children and 10 degrees
in adolescents. Children should follow up with orthopedic surgery within 1 week
of injury, and healing generally takes 4 to 6 weeks, depending upon the age of the
child.