Orthopaedia
In adults, simultaneous fractures of the shaft of the ulna and radius (the so-called "both bone fractures") are most often the consequence of a direct blow to the forearm or other high energy mechanisms. In the adult, these injuries usually require surgical fixation. By contrast, these injuries in the pediatric population result from simple falls and other lower energy mechanisms. In children, ulnar and radial shaft fractures are amenable to casting. Imperfect healing can lead to loss of...
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Orthopaedia
Nursemaid’s elbow is a common injury in very young children, and it occurs when the annular ligament subluxes and becomes trapped between the radial head and the capitellum. Most nursemaid’s elbows occur in children between 2 and 3 years old; and it is very uncommon after the age of 5. Nursemaid’s elbow occurs after a longitudinal force is applied to the forearm while it is pronated with the elbow in extension, like when a parent pulls on the child’s hand or forearm. The child usually presents with...
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Orthopaedia
Sternoclavicular (SC) injuries in skeletally immature patients can occur as a result of either a true sternoclavicular dislocation or a medial clavicular physeal separation. The medial clavicular physis is the last to ossify and can fuse as late as 25 years old, so physeal separations can occur in young adults as well. SC injuries are relatively uncommon and account for <1% of pediatric fractures. The clavicle more commonly displaces anteriorly to the sternum, but posterior displacement is...
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Orthopaedia
The rotator cuff comprises four muscles that originate on the scapula and insert on the humerus: the supraspinatus, infraspinatus, teres minor and subscapularis. Although these muscles have distinct effects on the humerus (often overlapping with non-rotator cuff muscles), the collective effect of the rotator cuff is to dynamically constrain the humeral head. Rotator cuff tears may be sudden and traumatic or gradual and attritional over time. Treatment ranges from benign neglect to surgical...
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Orthopaedia
The scaphoid (also known as the carpal navicular) is perhaps the most important of the eight carpal bones. The scaphoid links the carpal bones closest to the radius and ulna, the so-called the “proximal row,” to those articulating with the metacarpals, the “distal row.” Owing to its tenuous blood supply, the scaphoid is particularly susceptible to osteonecrosis (and ensuing post-traumatic arthrosis) after fracture. Unfortunately, the scaphoid is also the most commonly fractured of the eight...
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