Kids' FOOSH Injuries: What to Know!

Possible Outcomes:

1. Fractures:

   • Common sites: Distal radius and ulna, scaphoid, and metacarpals.
   • Types: Greenstick fractures, buckle (torus) fractures, complete fractures.

2. Growth Plate (Physeal) Fractures:

   • These involve the growth plate and can affect bone growth.
   • Classified by Salter-Harris types I-V depending on severity and involvement.
   • Require careful management to prevent growth disturbances.

3. Sprains:

   • Involve ligament injuries without fractures.
   • Commonly affect the wrist and fingers.
   • Symptoms include pain, swelling, and limited range of motion.

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Non-Surgical Treatments:

1. Immobilization:

   • Cast or splint immobilization is commonly used for fractures and significant sprains.
   • Duration depends on injury severity, typically 3-6 weeks.
   • Emphasis on proper alignment and immobilization to ensure healing.

2. Pain Management:

   • NSAIDs or acetaminophen for pain and inflammation.
   • Ice application to reduce swelling.

3. Physical Therapy:

   • After immobilization, therapy focuses on restoring range of motion, strength, and function.
   • Includes exercises and gradual return to activities.

4. Close Monitoring:

   • Frequent X-rays to monitor fracture healing and growth plate status.
   • Early detection of any growth disturbance or malunion.

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Surgical Treatments:

1. Indications:

   • Displaced fractures that cannot be adequately aligned by closed methods.
   • Open fractures or those involving joint surfaces.
   • Certain growth plate fractures (Salter-Harris III and IV) needing precise anatomical reduction.
   • Fractures unstable after closed reduction.

2. Procedures:

   • Closed Reduction and Percutaneous Pinning:
     • Minimally invasive, realigns bones and stabilizes with pins.
   • Open Reduction and Internal Fixation (ORIF):
     • Surgical exposure to directly align bones and fix with plates, screws, or wires.
   • Physeal Bar Resection:
     • If growth plate damage causes bony bar formation leading to growth arrest.

3. Post-Surgical Care:

   • Immobilization combined with monitoring healing progress.
   • Gradual rehabilitation similar to non-surgical treatment.
   • Follow-up imaging to ensure proper healing and growth.

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Summary

• Pediatric FOOSH injuries can result in a range of outcomes with growth plate injuries requiring special attention.
• Non-surgical treatment is often successful for non-displaced or minimally displaced fractures and sprains, emphasizing immobilization and monitoring.
• Surgical intervention is reserved for severe, displaced, or unstable injuries, focusing on restoring anatomy to prevent long-term complications.
• Multidisciplinary care including orthopedic surgeons, physical therapists, and primary care providers is important for optimal recovery.

If you would like, I can provide more detailed protocols or recent research papers on this topic.