ABSTRACT
This chapter discusses the regional approach to those most frequently encountered. Upper extremity injuries and fractures are common in children. Non-accidental injury must be considered in all cases; distal/lateral clavicle fractures have a higher specificity than middle/medial fractures. The sigmoid shaped clavicle allows for single anteroposterior radiographic evaluation, although cephalic tilt views aid assessment. Newborn proximal humerus physeal injuries are often misdiagnosed as congenital shoulder dislocations because the humeral head ossification centre is yet to appear. Distal radius fractures are common in children and may be associated with other injuries to the same limb. Percutaneous pinning with crossed K-wires is usually sufficient; open injuries and irreducible fractures may require open reduction. Indications for operative treatment include displaced Salter-Harris type III/IV injuries or those with associated dislocation or extensor tendon avulsion. Children present with a painful palpable deformity, skin tenting, bruising and crepitus. Tenderness is localized but can be diffuse with plastic deformation.
