2.  9 yo female presents c/o right
wrist pain after falling off of a
horse while at summer camp.
She complains of pain with
palpation and passive motion of
wrist. Ice was placed on injured
extremity at scene and she has
no other complaints.
 T:97.8F P:104 R:18 BP:104/78
O2:98%
 Gen: anxious but NAD
 HENT: no evid of trauma
 CV/Lungs:clear, mildly
tachycardic, RRR
 Abd: soft, NT, ND
 Ext: 2+ radial pulse with god cap
refill. Ulnar.Radial, Median
nerves intact to motor and
sensation. Mild swelling over
dorsum of right wrist, TTP, but
no obvious osseous abnormality.

4. E
P
M
D
No obvious
abnormality
is seen on
two views,
but pt
remains
tender on
exam.

5.  Solid neurovascular exam
 Plain films
 Analgesia
 If visible separation of epiphysis, will need
reduction
 If suspicion remains and x-rays appear normal,
splint and follow up with Ortho in 7 days for
repeat films.

6.  Salter Harris I is a fracture through the physis with
separation of epiphysis.
 Might not be readily visible on xray for up to one week
 Do not mistake injury as “sprain” when it is near a
growth plate.
 If unsure, splint and FU with orthopedics in 7-10 days
for repeat films.
 If treated correctly, complications are rare.

8.  http://www.feinberg.northwestern.edu/emergencyme
d/residency/ortho-
teaching/pediatrics/case23/case23edmanagement.htm
l
 http://www.hawaii.edu/medicine/pediatrics/pemxray/
v3c05.html
 http://rad.usuhs.edu/medpix/kiosk_image.html?imag
eid=21433&quiz=#pic
 Menkes, J.S. Orthopedic Injuries. Tintinalli’s
Emergency Medicine: A Comprehensive Study Guide
Chapter 267