Abstract
Fall on outstretched hand (FOOSH) injuries are common in pediatric and adult patients. FOOSH injuries affect the upper extremities, including the hand, wrist, forearm, elbow, upper arm, and shoulder. Clavicle fractures are the most common pediatric fractures following a FOOSH injury. Supracondylar humerus fractures are the most common elbow fractures in pediatric patients following a FOOSH injury. The scaphoid is the most common carpal bone fractured in a FOOSH injury. Proper identification and treatment of these injuries are important for good patient outcomes.
Keywords
clavicle, Colles fracture, FOOSH, fall, radius, scaphoid fracture, supracondylar fracture
4
Name a risk factor that can lead to decreased bone mineral density and can increase the risk of fracture in the pediatric population after a FOOSH injury
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Obesity in childhood and adolescence has been shown to decrease bone mineral density.
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Obese and overweight children also tend to fall more frequently with activity due to balance difficulties.
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Maintaining a healthy body weight can reduce the fracture risk from a FOOSH injury in the pediatric population.
7
Describe treatment options for children and adults with a clavicle fracture as a result of a FOOSH injury
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After diagnosing a clavicle fracture, patients can use a sling for 2 to 3 weeks to help with pain, if necessary. Early motion is also allowed if tolerated.
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A figure-of-eight brace can also be used, although a sling is typically more comfortable and less cumbersome to put on.
8
When assessing a patient with a FOOSH injury, what are the pertinent history items that need to be considered?
Pertinent historic items when assessing a FOOSH include:
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Mechanism of injury: How did the patient land? What was the direction and magnitude of the force to the extremity?
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History of prior injury.
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Any other associated signs or symptoms.
9
Which nerve needs to be assessed when evaluating a proximal humerus fracture sustained from a FOOSH injury?
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The axillary nerve needs to be assessed with a proximal humerus fracture. Carefully assess deltoid function and sensation over the lateral aspect of the proximal humerus.
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Any signs of neurovascular compromise should necessitate urgent evaluation with an orthopedic surgeon.
10
What injury should be considered in a pediatric patient who presents with a painful elbow and decreased range of motion following a FOOSH injury?
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Supracondylar fractures account for 60% to 80% of all pediatric elbow fractures, with the most common mechanism being FOOSH injury with elbow in hyperextension.
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Typically, these patients will have pain and swelling. Visible deformity may be present. These patients will often be quite uncomfortable when any physical examination is attempted.
12
Name the x-ray views necessary to evaluate for a supracondylar elbow fracture
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Standard elbow x-rays, including an AP and lateral view with elbow flexed at 90 degrees, typically are sufficient to visualize a supracondylar elbow fracture.
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Comparison views to unaffected side may be helpful to diagnose subtle abnormalities.
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Also consider imaging shoulder and wrist for associated injuries.
13
Describe the radiographic findings that are indicative of a supracondylar fracture, even if no fracture line is clearly visible
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A fracture may still be present despite the absence of a clear fracture line.
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The presence of a posterior fat pad or an anterior fat pad is indicative of an intraarticular fracture with associated effusion and hemarthrosis.
16
What are the common complications of a supracondylar humerus fracture?
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Cubitus varus angulation can form with loss of normal carrying angle, which is mostly secondary to malreduction or loss of reduction.
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Nerve injury to radial or median nerve, which is usually a neurapraxia (impairment in nerve conduction), that will resolve within a few weeks.
18
Describe the typical distribution of fractures within the scaphoid following a FOOSH injury
Of scaphoid fractures, 80% occur at the scaphoid waist; 10% affect the proximal pole, and 10% affect the distal pole. Waist fractures and proximal pole fractures have the highest risk of avascular necrosis.
19
Describe common physical examination findings for a patient with a scaphoid fracture
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Patients with a scaphoid fracture may have radial-sided wrist pain with associated swelling. Typically, these patients have localized tenderness over the anatomic snuffbox. The snuffbox is located on the dorsal wrist between the tendons of the extensor pollicis longus medially and the extensor pollicis brevis and abductor pollicis longus laterally.
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Tenderness over the anatomic snuffbox is the most sensitive physical examination finding. Sensitivity ranges from 0.87 to 1.00 ( Fig. 34.1 ).
Fig. 34.1
