Pediatric Upper Extremity Injury Management
Summary
The management of upper limb injuries in children centres on timely recognition, appropriate imaging, accurate reduction, and functional rehabilitation. The spectrum includes common radial head subluxation (nursemaid’s elbow), supracondylar and physeal fractures of the distal humerus, forearm fractures, elbow dislocations, and less frequent proximal injuries. Clinical assessment focuses on pain, range of motion, swelling and neurovascular status. Radiography remains the mainstay for most fractures, whereas point-of-care ultrasound is increasingly used for joint effusion, occult fractures and subluxations. Closed reduction and immobilisation in above-elbow casts or splints are standard for displaced fractures, with gentle manipulation techniques for subluxations. Cast duration is guided by bone healing rates and potential for growth plate disturbance. Early physiotherapy promotes functional recovery and minimises stiffness. Management strategies must consider the child’s developmental stage, fracture pattern, and potential for remodelling. Worldwide, streamlined protocols and training in reduction techniques have reduced emergency department stays, improved outcomes and minimised radiation exposure.
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Pediatric Upper Extremity Injury Management publication trend
The graph below shows the total number of articles in pediatric upper extremity injury management across all publications each year (not limited to Nature Index journals).
Technical terms
Radial head subluxation (pulled elbow): Partial displacement of the radial head from the annular ligament, commonly seen in children aged 1–4 years following longitudinal traction of the forearm.
Point-of-care ultrasound (POCUS): Bedside ultrasonography used by clinicians to visualise musculoskeletal structures, detect effusions or occult fractures, and guide management decisions in real time.
Reduction manoeuvre: A controlled sequence of movements, such as hyperpronation or supination-flexion, employed to realign a dislocated or subluxed joint without surgery.
Physeal injury: Damage to the growth plate (physis) in paediatric bones, requiring careful management to prevent growth disturbances.
Effusion: Accumulation of fluid within a joint capsule, often indicating haemarthrosis or inflammation following trauma, detectable by ultrasound or radiography.
References
- Epidemiology Of Nursemaid's Elbow. Western Journal of Emergency Medicine (2014).
- Investigation on 2331 cases of pulled elbow over the last 10 years. Pediatric Reports (2014).
- What is the Role of Point of Care Ultrasound for Suspected Pulled Elbow in Children? A Narrative Literature Review.. POCUS Journal (2025).
- Use Of POCUS for the Paediatric Patient with an Undifferentiated Upper Limb Injury. POCUS Journal (2023).
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