What is the primary goal in managing a pediatric patient with a non-bleeding fracture?

Primary Goal in Managing Pediatric Non-Bleeding Fractures

The primary goal when a mother brings a child with a non-bleeding fracture to a healthcare provider is preventing further injury, displacement, and complications while ensuring proper healing and return to full function. 1, 2

Immediate Prevention Priorities

Preventing Fracture Displacement

• Immobilization is the cornerstone of preventing displacement in non-displaced or minimally displaced fractures. 1, 3, 2
• For non-displaced fractures, posterior splint immobilization provides superior pain control compared to collar and cuff methods and should be maintained for a minimum of 3 weeks. 1, 3
• Radiographic follow-up during the first 3 weeks is essential to confirm the fracture remains non-displaced, as redisplacement occurs in 7-13% of cases, usually within 2 weeks of injury. 3, 4

Preventing Vascular Compromise

• Assess and document neurovascular status immediately, as vascular compromise can lead to long-term loss of nerve and muscle function. 1
• For fractures with vascular injury and absent pulses after reduction, open exploration of the antecubital fossa is recommended. 5, 6
• Management includes warming the extremity, vascular surgery consultation, and in-hospital observation for at least 24 hours after vascularity is restored. 5, 6

Preventing Refracture and Complications

• Most pediatric fractures heal without long-term complications when managed with appropriate immobilization and follow-up. 7, 2
• The healing process in children is less complicated, remodeling capacity is higher, and non-union is rare compared to adults. 2
• Repeat radiographs at cessation of immobilization (around 3 weeks) before advancing rehabilitation to prevent premature activity resumption. 3

Secondary Prevention Goals

Preventing Loss of Function

• The ultimate goal is returning the child to full, age-appropriate function with the ability to reach maximum adult potential. 1
• Early active motion is critical once appropriate healing has occurred to prevent stiffness. 5, 6
• Physical, occupational, and play therapy are essential elements of comprehensive rehabilitation for injured children. 1

Preventing Psychological Trauma

• Address acute stress and posttraumatic stress reactions in trauma patients. 1
• Crisis intervention and ongoing support should be offered, particularly for youth injured through interpersonal violence who are at risk of repeat injuries. 1

Preventing Missed Child Abuse

• Healthcare providers must remain vigilant for signs of potential child abuse when evaluating pediatric fractures. 1
• Be aware of state reporting requirements and facilitate early detection of abuse and neglect. 1

Common Pitfalls to Avoid

• Do not use collar and cuff as primary immobilization for non-displaced fractures, as it provides inferior pain control compared to posterior splinting. 1, 3
• Do not skip radiographic follow-up during the first 3 weeks, as displacement can progress and may require surgical intervention if detected early. 3
• Do not resume unrestricted activity too early, as this increases the risk of refracture. 1
• Do not assume all fractures can be managed conservatively—surgical treatment is indicated for displaced fractures, open fractures, fractures with vascular injuries, and certain anatomic locations requiring precise reduction. 8, 2