25 - Pediatric Orthopedic Emergencies

soft tissue abnormality. Radiographs are unnecessary unless another particular injury is suspected. Edema and tenderness are present with supracondylar fractures. A number of reduction techniques are used, including the hyperpronation method and the supination-flexion method. The hyperpronation method has proved more effective and appears to be less traumatic. With the arm held in extension, the wrist is hyperpronated and a click is sometimes heard. In the supination-flexion approach the examiner places the thumb of one hand over the radial head and provides countertraction. Next, while holding the wrist, the elbow is pulled into extension. The final phase is supination and flexion at the elbow. Most children return to full functioning within 15 minutes, and the child should be observed until full range of motion is regained. When multiple reductions fail, radiography should be considered. In a child with failed reduction and negative radiographic findings, a sling or posterior splint is necessary with close orthopedic follow-up.