Paediatric Fractures

Question 1

Percentage of children that will sustain a fracture

Answer 1

20%

Question 2

Causes of fractures in children

Answer 2

Accidental, non-accidental and pathological

Question 3

Where are the majority of fractures in children

Answer 3

The upper limb

Question 4

How many bones are present in a child at birth

Answer 4

270 bones, before ossification

Question 5

Ossification

Answer 5

They become increasingly cartilaginous before the process of ossification begins to eventually leave us with what we recognise as bones.

Question 6

Consequences of ossification occurring at different times

Answer 6

Confusion as to what is being seen on an X-ray

Determine the bone age of a child

Question 7

Ossification ages

Answer 7

Capitellum (1)
Radial head (3)
Internal (medial) epicondyle (5)
Trochlea (7)
Olecranon (9)
External (lateral) epicondyle (11)

Question 8

Factors that affect age of ossification

Answer 8

Gender, and genetics

Question 9

Common fracture in children

Answer 9

Supracondylar Fracture and tend to occur in children aged 3-9.

Question 10

Type 1 Supracondylar Fracture

Answer 10

Undisplaced. Fat pad present acutely

Question 11

Type 2 Supracondylar Fracture

Answer 11

Hinged posteriorly. Anterior humeral line anterior to the capitellum

Question 12

Type 3 supracondylar fracture

Answer 12

Displaced. No meaningful cortical continuity.

Question 13

Type 4 Supracondylar fracture

Answer 13

Displaces into extension and flexion. Usually diagnosed with manipulation under fluroscopic imaging.

Question 14

Median comminution

Answer 14

Collapse of the medial column. Loss of Baumann’s angle

Question 15

Where is the bone most likley to fail in children.

Answer 15

Metaphysis.

Question 16

Pattern of fracture in children

Answer 16

Bend, plastic deformation, buckle or torus fracture, greenstick fracture, complete fracture, physeal injury.

Question 17

Physeal Injuries

Answer 17

Physes are more susceptible to injury from roational forces rather than angulation or traction.

Question 18

Periosteum in children

Answer 18

Much thicker. Part of the periosteum will be torn in a fracture but the intact part can be used to ensure fracture stability after reduction.

Question 19

Bone remodelling in children

Answer 19

Greater capacity to remodel so some residual angilation after reduction may be acceptable.