Childrens fractures Flashcards
In close wounds, how does bevelling indicate order? (for applied ballistics)
1st injury has more bevelling then 2nd injury
What is a common mechanism of injury in kids?
falling
Why are “healthy” kids less injured from falls then adults or older kids?
They are lighter, shorter, slower and more flexible. Thicker periosteum
Why do kids have more bone flexibility?
higher proportion of water, larger haversian canals, more porous bones, slightly lower mineral cotent
What beneficial role does the periosteum play in children fractures?
more rapid healing and initial stability. remain a hinge in most breaks
What is the weakest place on a childs bone?
the epiphyseal plates (growth plates) because they are uncalcified. Ligaments are stronger than growth plates.
Growth plate rates?
may differ at opposite ends in quickness of growth
Injury to growth plate?
May cause complete cessation of bone growth at that plate! or one side may stop and the other continue causing irregular growth
Why is the quick healing sneaky?
child abuse can be easily covered
children’s and adults bone difference?
adults are static, children’s are dynamic (structural and functional) and are susceptible to different fracture patterns
Presence of unfused epiphyses and growth centres
Time related variation in childrens fractures?
temporal variations closely with progressive anatomic changes.
What is the 2nd most common cause of child morbidity?
severe trauma. After infection
What is the leading cause of polytrauma?
MVA
Toddlers:
Schoolchildren:
distal forearm, ankle, foot.
fractures of skull, tibial shaft.
Compositional differences
- have higher proportion of water
- have larger Haversian systems
- are more porous
- have slightly lower mineral content – allows greater elasticity and plasticity of bone
Epiphysis and physis are responsible for what?
bone growth: shaft length, contour of bone ends, axial relationships at joints
Epiphyseal Injury
Epiphyseal separation in children is analogous to ligament injury or dislocation in adult.
Bone strength vs. ligament strength
Joint capsule and ligaments are 2-5 X stronger in children than physis.
Hence, trauma that causes ligament injury or dislocation in adult will more likely cause epiphyseal separation or fracture in child.
most common type fracture?
Greenstick fracture:– about 50% of children’s fractures.
Chondroepiphysis:
each epiphysis is a complete cartilaginous structure at end of each long bone at birth (except distal femur);
What is the corresponding ossifying structure to chondroepipysis?
is the chondro-osseous epiphysis.
What is important to remember about chondroepiphysis?
exhibit variations in the appearance of the ossification centers, a factor that must be considered to appropriately diagnose fractures of these regions
In particular this applies to the multiple epiphyses of the distal humerus
What is a physis?
physis = growth plate = epiphyseal plate
Primary agent of endochondral ossification pre- and postnatally
Contour of most physes _______ during development. except in the______.
does not change a great deal
exceptions are physes in proximal humerus and proximal femur
Because the contours [of the epiphyses] are undergoing constant change,
fracture pattern susceptibilities also change
what accelerates longitudinal bone growth?
resection (cutting) of periosteum
what are the common incomplete fractures found in children?
- classic greenstick
- torus
- bowing
Greenstick fracture:
due to angulation (bending) forces; convex side is in tension, concave side is in compression – incomplete transverse fracture occurs on tension side; fracture line then becomes longitudinal (in proximal or distal shaft or both); mainly radius, ulna, clavicle.
Torus fracture:
buckling of cortex due to compression; may be subtle; usually near ends of long bones (metaphyseal regions); microfractures allow buckling to occur without an overt fracture line.
Lead pipe fracture:
combination – incomplete transverse fracture affecting one cortex (bending or angulation force), torus fracture of opposite side (compression force); uncommon; in metaphysis.
Bow, or plastic bowing, fracture:
bending of bone due to angulation force without any macroscopically visible evidence of fracture; especially in radius and ulna, less in fibula.
Bow fracture conforms to______ of stress-strain curve
plastic deformation region,
(elastic limit has been exceeded, hence bone can not return to pre-load state).
Bowing in forearm may interfere with what motions?
pronation and supination
what energy source can also cause long bone to bow?
heat
