Pediatric emergency medicine trisk 3409 3409

CHAPTER 111 ■ MUSCULOSKELETAL TRAUMA RACHEL W THOMPSON, MEGAN HANNON, LOIS K LEE GENERAL PRINCIPLES OF PEDIATRIC ORTHOPEDICS Goals of Emergency Therapy Orthopedic trauma currently accounts for 10% to 15% of emergency department (ED) visits in urban pediatric hospitals The number and spectrum of musculoskeletal injuries sustained by children and adolescents appear to be on the rise since the mid-1990s, in part because of the rapid growth of organized sports and other youth recreational activities As a consequence of their skeletal immaturity and the associated anatomic and physiologic differences in bony structure, pediatric standards of care, fracture patterns, and outcomes are different than in the adult population Thus, the emergency clinician must maintain a high level of suspicion for fracture in the child presenting with focal bony pain, even in the absence of obvious deformity Priorities in the emergency care of these patients include the recognition and treatment of pain by both pharmacologic and other comfort measures, and the consideration of using minimal radiation when possible, given the evidence of the inverse correlation of age and risk of radiation-associated malignancy Finally, emergency care is performed with the ultimate goal of preserving long-term function This requires recognizing and addressing factors that may otherwise lead to complications, such as neurovascular compromise, open injuries at risk for infection, and physeal injuries that may lead to growth disturbance KEY POINTS