Paediatric Trauma: Fractures & classification

Question 1

describe how fractures in the bones of children can differ to those in adult bones

Answer 1

children’s bones are more elastic and pliable and tend to buckle or partially fracture or splinter rather than break completely

Question 2

give some examples of types of fracture seen in children’s bones

Answer 2

buckle fracture or greenstick fractures

Question 3

describe what a greenstick fracture is

Answer 3

when the ‘fibres’ of the bone splinter and appear as if breaking a green stick from a tree

Question 4

which part of the bone tends to remain intact in children’s fractures and why

Answer 4

the periosteum as it is much thicker

Question 5

describe why children’s bones heal more quickly than those of adults

Answer 5

due to thicker periosteum which is a rich source pf osteoblasts

Question 6

describe why children’s bones have a greater potential to remodel than adult bones

Answer 6

because they grow with bones being formed along the line of stress and children can correct angulation up to 10 degrees with every year of growth

Question 7

describe the general treatment of children’s fractures

Answer 7

less surgical treatment due to remodelling potential, even if unacceptable position may only need manipulation and cast

Question 8

in general how does surgical management, if needed, differ in children to that of adults

Answer 8

less invasive temporary pins, wires and flexible rods tend to be used. Plates and screws reserved for only very unstable

Question 9

at what point are children’s fractures treated as adults, due to decreasing remodelling potential

Answer 9

once child reaches puberty (around 12-14)

Question 10

describe what complication can arise if fracture causes damage to the physis in a child’s bone

Answer 10

can disturb growth, could result in shortened limb or angular deformity

Question 11

what classification system is used for physeal fractures

Answer 11

Salter-Harris classification, I toV, I best prognosis, V being worst

Question 12

describe what Salter-Harris I classification fractures involves

Answer 12

pure physeal separation, least likely to arrest growth

Question 13

what classification do most physeal fractures come under

Answer 13

Salter-Harris II

Question 14

describe what Salter-Harris II classification involves

Answer 14

similar to I but has a small metaphyseal fragment attached to the physis and epiphysis, not likely to arrest growth

Question 15

describe the Salter-Harris III and IV classification fractures

Answer 15

intra-articular with the fracture splitting the physis, greater potential for growth arrest

Question 16

describe the Salter-Harris V classification fractures

Answer 16

compression injury to the physis and subsequent growth arrest