Fractures in Children

Question 1

Epiphyseal fracture type I

Answer 1

Physis fracture. Straight across

Plate fracture. good outcomes with function not stopped. Don’t need screw

Question 2

Epiphyseal fracture type II

Answer 2

metaphysis and physis fracture. Across half and up diagonal.

Plate fracture and break in shaft.

Decent outcomes with only have of plate still normal.

Bone may grow different and might need screw to attach plate.

Question 3

Epiphyseal fracture type III

Answer 3

epiphysis and physis fracture. Half across and down.

articular cartilage involved.

need screw and surgery to protect growth and cartilage.

Question 4

Epiphyseal fracture type IV

Answer 4

Epiphysis to metaphysis fracture. Straight down edge.

Surgery if displacement is bad.

WB in foot may displace more

Question 5

Epiphyseal fracture type V

Answer 5

crush fracture

crushed plate. High chance plate lost. Need to open up.

Question 6

Epiphyseal fractures

Answer 6

85% uncomplicated (type I)

15% complicated-depends on damage to plate (type V stops growth, type II asymmetrical growth)

Question 7

Epiphyseal fracture treatment

Answer 7

Orthopedic tx- non surgical for type I and II. Surgical for type III and IV. LESS immobilization time than metaphyseal fracture because plate is active. Type V depends on age of subject-might need orthosis.

PT tx- pain and/or edema is #1. Limit ROM. Decreased strength. Decreased independence. Presence wound.

Question 8

Upper extremity fractures

Answer 8

Shoulder-proximal humeral epiphysis. Conservative (non displaced), percutaneous pinning (displaced)

Clavicle- most common/least serious. Normally no surgery.

Question 9

Arm and elbow fractures

Answer 9

Humeral shaft: Not very common. High energy fx. Stable (shoulder spica cast)/Unstable (traction, surgery).

Elbow: supracondylar fx- hyperEXT mechanism.

Epicondyle fractures- medial (avulsion), lateral (compacted)

Proximal radial epiphysis- type II epiphyseal fx.

MAIN CONCERN= epiphyseal plates

Question 10

Forearm and wrist fractures

Answer 10

proximal third of radius and ulna (monteggia fx)-includes a dislocation of proximal radio-humeral joint

Galeazzi fx-radial shaft fracture with dislocation of the distal radioulnar joint

Question 11

Lower extremity fractures

Answer 11

femoral neck fx

• very high energy fx
• precarious blood supply (avascular necrosis)
• internal fixation (dynamic hip screw-DHS)

Question 12

femoral shaft fractures (FSF)

Answer 12

fracture between 5cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle (midshaft)

One of most common fractures of LE in children from traumatic injury

Question 13

Types of femoral shaft fractures

Answer 13

type I: minimal or no comminution at the fracture site, stable after intramedullary nailing

type II- fracture with comminution leaving at least 50% of the circumference of the two major fragments intact

type III: fracture with comminution of 50-100% of he circumference of the major fragments

type IV: fracture with completely comminuted segmental pattern with no intrinsic stability

Question 14

FSF treatment

Answer 14

Medical- No consensus regarding postop immobilization. No full WB until callus formed.

PT- recommended for pts who are not progressing in typical pattern with regard to ROM, strength, and normalization of gait. RTS 12-16 weeks after fixation with solid bone healing and strength/ROM.

Question 15

Knee

Answer 15

epiphyseal fx’s- femoral supracondylar, proximal tibial epiphysis, and internal fixation.

Avulsion fx of anterior tibial spine- ACL stronger than bone.

Question 16

Ankle fractures

Answer 16

ankle can have all 4 types of epiphyseal fractures-normally surgically reduced and involve pinning

Question 17

Dislocations

Answer 17

upper extremity: pulled elbow (nursemaid’s elbow)

Question 18

fracture healing in children

Answer 18

more common

stronger and active periosteum

rapid fracture healing