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Plain extremity radiographs are indicated in pediatric patients with significant mechanism of injury, pain, limitation of use or motion, or physical exam evidence of deformity, swelling, or tenderness. The joint above and below the site of injury should be examined, and radiographs of adjacent joints should be obtained when indicated. Pediatric extremities consist of growing bones and ossifications centers, with wide variability in normal-appearing bones based on age. As the physic itself is radiolucent, physeal fractures are not always evident on initial plain radiographs. Minimum views of the extremity should include anteroposterior (AP) and lateral. Negative initial plain radiographs do not exclude a Salter-Harris type 1 physeal fracture. If a pediatric patient has negative films but significant swelling or point tenderness along the physic of a bone, a physeal fracture and splint can be assumed accordingly. The incidence of sprains and dislocations are less common in children than in adults.
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