Pediatric emergency medicine trisk 3409 3409

CHAPTER 111 ■ MUSCULOSKELETAL TRAUMA
RACHEL W. THOMPSON, MEGAN HANNON, LOIS K. LEE

GENERAL PRINCIPLES OF PEDIATRIC ORTHOPEDICS
Goals of Emergency Therapy
Orthopedic trauma currently accounts for 10% to 15% of emergency department
(ED) visits in urban pediatric hospitals. The number and spectrum of
musculoskeletal injuries sustained by children and adolescents appear to be on the
rise since the mid-1990s, in part because of the rapid growth of organized sports
and other youth recreational activities. As a consequence of their skeletal
immaturity and the associated anatomic and physiologic differences in bony
structure, pediatric standards of care, fracture patterns, and outcomes are different
than in the adult population. Thus, the emergency clinician must maintain a high
level of suspicion for fracture in the child presenting with focal bony pain, even
in the absence of obvious deformity. Priorities in the emergency care of these
patients include the recognition and treatment of pain by both pharmacologic and
other comfort measures, and the consideration of using minimal radiation when
possible, given the evidence of the inverse correlation of age and risk of
radiation-associated malignancy. Finally, emergency care is performed with the
ultimate goal of preserving long-term function. This requires recognizing and
addressing factors that may otherwise lead to complications, such as
neurovascular compromise, open injuries at risk for infection, and physeal
injuries that may lead to growth disturbance.
KEY POINTS