Fractures and trauma Flashcards
Which children are predisposed?
Those which have:
- low bone density - OGI
- neuromuscular disorders - CP, spina bifida
- ‘fracture personality’
Physiological differences between children and adults
Thick articular cartilage = not seen on X-ray
Thick periosteum = rapid healing
Increased collagen content = fracture more easily
More cancellous bone = simpler fracture patterns
Growth plates = remodel better
Stronger ligaments = bones fail first, dislocation rarer
Buckle fractures
Kink in the bone - thick periosteum keeps it together
Greenstick fractures
Bone broken but at the back remains intact because of thick periosteum
Physical/growth plate injuries
Physical insults also due to infection, tumour or ischemia
Can affect growth and remodelling
Fractures occur through the zone of provisional calcification
Salter-Harris classification 1
Separation straight through the physis
Salter-Harris classification 2
Through the physis with a metaphyseal fragment
Salter-Harris classification 3
fracture through the epiphysis not extending into the metaphysis
Salter-Harris classification 4
fracture through the epiphysis and metaphysis
Salter-Harris classification 5
Stress injury due to abnormal pressure across physis can lead to growth arrest
Salter-Harris classification 6
Crush injury to periphery of the physis
Solution to physical/growth plate injuries
Osteotomy at maturity
Principles of fracture reduction metaphyseal/diphyseal fractures expected outcomes
The younger the better
Closer to the physis the better
Upper humerus best
Management of fractures options
Immobilisation only
Manipulation and plaster of Paris
Manipulation and wiring
Open reduction and internal fixation - ORIF
