ped fractures Flashcards
What are 3 primary ways fx in children differ from adults
manner in which they occur, how they heal, and how they are managed.
How are fractures described
location, complete (transverse, oblique or spiral) vs imcomplete,
classification of fractures by location
- Diaphyseal
- metaphyseal
- physeal
- epiphyseal
- articular
- epicondylar
- supracondylar
- transcondylar
- intercondylar
- subcapital
special feature of fx and dislocations in children
- fracture more common
- stronger and more active periosteium
- jt injuries, torn ligament and dislocations less common in children
- special problems of dx: varying radiographic appearance
- more rapid healing
- spontaneous correction of certain residual deformities
- differences in complications: disturbance of epiphyseal plate, higher osteomyelitis, compartment syndrome
- different emphsasis on methods of tx
- in children, fx can stimulate longitudinal growth leading in some causes to over growth of fx bone
- less tolerance of major blood loss
Salter harris classificaiton of Epiphyseal palte injuries Type I
- Fracture lines follow the growth plate. Complete separation of the epiphysis from the metaphysis
- the growing cells of the epiphyseal plate remain with the epiphysis
- usually result of shearing force
- more common in newborns and in young children in whom epiphyseal plate is relatively thick
- treat with closed reduction
- prognosis is good
Salter harris classificaiton of Epiphyseal palte injuries Type II
-most common type
-line of fracture-separation extends along the epiphyseal plate to a variable distance and then out through a portion of the metaphysis thereby producing a triangular- shaped metaphyseal fragment
Mechanism: shear or avulsion with angular force
-usually with older children
*periosteum is torn on the convex side of the angulation but intact on the concave side
*closed reduction with stabilization
*prognosis is good
Salter harris classificaiton of Epiphyseal palte injuries Type III
- fracture is intra-articular, extends from the joint surface to the deep zone of the epiphyseal plate and then along the plate to periphery
- uncommon
- caused by intraarticular shearing
- tx is open reduction
- prognosis is good provided blood supply has not been disrupted
Salter harris classificaiton of Epiphyseal palte injuries Type IV
- intraarticular fracture; extends from the joint surface through the epiphysis across the entire thickness of the epiphyseal plate and through a portion of the metaphysis
- the most common type IV is a fx of the lateral condyle of the humerus
- Treat: with open reduction and internal fixation
- prognosis is BAD unless PERFECT reduction is both obtained and maintained—potentially interferes with normal growth
Salter harris classificaiton of Epiphyseal palte injuries Type V
- relatively uncommon injury; if it occurs it is most common in the knee or ankle
- results form severe crushing force being applied through the epiphysis to one area of the epiphyseal plate; severe axial loading
- epiphysis NOT usually displaced
- avoid wt. bearing for 3 weeks
- prognosis is POOR; some or all of the physis is so severely compressed that growth potential is compromised
Salter harris classificaiton of Epiphyseal palte injuries Type VI
rare injury to peripheral perichondrial ring which encircles the plate
*caused by direct blow or more often due to an open slicing mechanism by a sharp object (blades, lawnmower)
bad prognosis
How long does it take a type 1-3 classification of epiphyseal pate take to heal
2-3 weeks
How long does type 4-5 take to heal for an epiphyseal plate
6 weeks
What can affect the prognosis regarding growth disturbances
- type of injury/classification
- age of child
- blood supply to epiphysis
- method of reduction
- open vs closed injury
