Instructional Course Lecture   |    
The Operative Management of Pediatric Fractures of the Upper Extremity
John M. Flynn, MD; John F. Sarwark, MD; Peter M. Waters, MD; Donald S. Bae, MD; Laura Powers Lemke, MD
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

John M. Flynn, MD
Division of Orthopaedics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4343

John F. Sarwark, MD
Children's Memorial Hospital, 2300 Children's Plaza, Orthopaedics 69, Chicago, IL 60614-3318

Peter M. Waters, MD
Donald S. Bae, MD
Department of Orthopaedic Surgery, Children's Hospital, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115

Laura Powers Lemke, MD
Department of Surgery, Southern Illinois University, School of Medicine, P.O. Box 19638, Springfield, IL 62794-9638

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Printed with the permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2003 in Instructional Course Lectures, Volume 52. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

J Bone Joint Surg Am, 2002 Nov 01;84(11):2078-2089
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The vast majority of pediatric fractures of the upper extremity can and should be treated with closed reduction, immobilization, and close follow-up. However, there is an ongoing debate in the orthopaedic community regarding the exact role of surgical management in the treatment of pediatric fractures 1 . In the past two decades, operative management of certain fractures (e.g., percutaneous pinning of displaced supracondylar fractures) has provided better results than closed management. Surgical management is clearly indicated for certain injuries, such as those requiring anatomical realignment of the physis or articular surface. Increasingly, however, surgical management is being used to maintain optimal alignment or to allow early motion. In many such cases, both nonoperative and operative methods have yielded good results and have vocal advocates. Certain technical advances, such as flexible intramedullary fixation and bioreabsorbable implants, have further increased enthusiasm for operative management of pediatric fractures.
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    fracture ; pediatrics

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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