Pediatric Arm Injury Evaluation and Management

Patient Assessment

The American College of Radiology recommends documenting the exact mechanism of injury, including how the fall occurred, height of fall, and landing position, for pediatric patients with suspected arm fractures 1, 2
The American College of Radiology suggests recording time of injury and evolution of symptoms since injury for pediatric patients with arm injuries 2
The American College of Emergency Physicians recommends documenting pain characteristics, including location, severity using age-appropriate pain scale, and aggravating/alleviating factors, for pediatric patients with arm injuries 3
The American College of Radiology advises noting any previous similar injuries, including history of clavicle fracture, for pediatric patients with arm injuries 4, 5
The American College of Radiology recommends assessing neurovascular status, including pulse strength, capillary refill time, sensation, and motor function, for pediatric patients with arm injuries 6

The American College of Radiology recommends radiographic confirmation, including anteroposterior and lateral projections, as the standard of care for diagnosis of suspected arm fractures in pediatric patients 1, 7
The American College of Radiology suggests evaluating growth plate involvement, which may require additional imaging or orthopedic consultation, for pediatric patients with upper extremity injuries 6

The American College of Radiology recommends a specific treatment plan based on radiographic findings, including immobilization details and pain management strategy, for pediatric patients with arm injuries 1, 7
The American College of Emergency Physicians suggests providing patient/family education regarding care of injured extremity, including follow-up recommendations and return precautions, for pediatric patients with arm injuries 2, 3
The American College of Radiology advises activity restrictions with a specific timeframe for pediatric patients with arm injuries 2

The American College of Radiology warns against failing to examine the joints above and below the injury site, inadequate pain management, and missing growth plate injuries, which may not be obvious on initial radiographs, for pediatric patients with arm injuries 6
The American College of Emergency Physicians cautions against incomplete neurovascular assessment documentation and inadequate follow-up instructions for parents/caregivers for pediatric patients with arm injuries 2, 3, 5, 6