Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!


  • Small children with a clavicle fracture may present with refusal to move the arm after a fall.

  • Children are more likely to suffer a Salter–Harris type II fracture separation of the proximal humerus than a true shoulder dislocation.

  • Indirect radiographic evidence of elbow fracture includes the presence of a posterior fat pad, an exaggerated anterior fat pad, and an abnormal radiocapitellar or anterior humeral line.

  • Supracondylar fractures of the humerus can be associated with acute and delayed neurovascular compromise and require immediate orthopedic consultation.

  • Fracture of the radius or ulna requires radiograph evaluation of the elbow and wrist to determine if a Monteggia or Galeazzi fracture is present.

  • The normal cascade of the resting hand shows increasing flexion from the index to little fingers and from the distal interphalangeal (DIP) joints to the metacarpophalangeal (MCP) joints. Deviation from this normal cascade implies a tendon injury until proven otherwise.

  • A Salter–Harris type I or II fracture of the distal phalanx may not be seen on radiograph. Look for a mallet deformity and inability to extend the DIP joint.

  • As in adults, scaphoid fractures are the most commonly encountered carpal fracture.


Children are prone to injuries of the upper extremity due to their natural curiosity, being active in sports, and risk-taking behaviors. Boys incur more injuries than girls, with the highest incidence of injuries occurring between 10 and 18 years of age. This chapter reviews the diagnosis and management of injuries to the upper extremities and hands.


The clavicle is the most commonly fractured bone during delivery and is the fourth most commonly fractured bone in older children, accounting for approximately 15% of all pediatric fractures.1 The clavicle is prone to fracture since the majority of its length resides subcutaneously, and functionally it distributes almost all forces from the upper extremity to the trunk. Fractures of the clavicle are categorized anatomically: medial third, middle third, and distal third.2 The vast majority of injuries involve the area between the middle and distal third of the clavicle (>90%),3 and the majority are due to a direct fall onto the lateral aspect of the shoulder. Direct blows only account for about 10% of midshaft fractures, and an indirect mechanism, such as falling on an outstretched hand, accounts for less than 5% of these injuries.4 Young children can sustain incomplete injuries (green-stick or bowing fractures).


Fractures of the medial clavicle are rare in children. The medial clavicular epiphysis is the last growth plate to close, allowing physeal injuries to occur up to age 25. In contrast to adults, in whom sternoclavicular (SC) joint dislocations occur more frequently, children are most likely to experience a posteriorly displaced Salter–Harris type I or II fracture of the medial ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.