Pediatric FOOSH Differential Diagnosis

The term "FOOSH" stands for "Fall Onto an Outstretched Hand," a common mechanism of injury in children that can lead to various wrist and forearm injuries. Here's a differential diagnosis organized by categories:

• Single Most Likely Diagnosis

  • Torus Fracture (Buckle Fracture): This is the most common type of fracture in children due to FOOSH, resulting from compression of the bone. The bone "buckles" but does not completely break, making it a stable injury that often heals quickly.

• Other Likely Diagnoses

  • Greenstick Fracture: A type of fracture where the bone bends and partially breaks, common in children due to the flexibility of their bones.
  • Salter-Harris Type I Fracture: An injury to the growth plate, which can be caused by a FOOSH mechanism. It's crucial to identify and manage these fractures to prevent growth disturbances.
  • Colles' Fracture: Although more common in adults, a Colles' fracture (a break at the distal end of the radius bone) can occur in children, especially as they get older.

• Do Not Miss Diagnoses

  • Galeazzi Fracture: A fracture of the radius with dislocation of the distal radioulnar joint. This injury requires prompt recognition and treatment to avoid complications.
  • Monteggia Fracture: A fracture of the ulna with dislocation of the proximal radioulnar joint. Missing this diagnosis can lead to chronic pain, limited mobility, and complications.
  • Scaphoid Fracture: While less common in young children, a scaphoid fracture can occur in older children and adolescents. It's a "do not miss" diagnosis due to the risk of avascular necrosis if not properly treated.

• Rare Diagnoses

  • Forearm Shaft Fractures: Fractures of both the radius and ulna can occur but are less common in the context of a FOOSH injury in children.
  • Isolated Ulnar Fracture: A solitary fracture of the ulna is rare but can occur, especially with a direct blow to the ulna or a fall onto the forearm.

Each of these diagnoses has a different treatment approach, ranging from immobilization and observation for torus and greenstick fractures to surgical intervention for more complex injuries like Galeazzi or Monteggia fractures. Accurate diagnosis is crucial for appropriate management and to prevent long-term complications.