Pediatric Fractures Flashcards
True or false:
children get more fractures than adults with less trauma?
true
when are fractures more concerning in kids than in adults?
when there’s physeal disruption (in 15% of fractures) that can lead to growth disrubances
What two general types of fractures (related to pattern of fracture) are more common in kids than adults?
greenstick fractures and torus (buckling) fractures
Where does more of the growth of the legs come from?
How about growth of the arm?
67% of leg growth is from growth plates around knee
80% of arm growth is from growth plates of the proximal humerus and distal radius
Where do fractures typically occur in the epiphyseal plate (aka what layer)?
in the relatively weaker hypertrophic zone
Which age group is more likely to get fractures trhough the growth plate?
which geneder and why?
teenagers
males because their growth plates are open longer
Growth plate fracutres more often occur on the ___ end, except the _____.
the distal physis is more often involved except for the proximal humerus
In general what is the salter-harris classifications of fractures?
1 : transverse fracture just proximal to the growth plate
- longitudinal fracutrewhich splits part of thegrowth plate with the diaphysis - doesn’t cross the physis
- fracture through the epiphysis involving the growth plate
- fracture through the epiphysis and part of the diaphysis, involving the growth plate
- crushing injury
What are the 4 general treatment options for physeal fractures?
immobilization
closed reduciton
percutaneous fixation
internal fixation
Why do Salter 3 and 4 fractures require perfect anatomic reduction?
because they are intraarticular
Why do physeal fractures need close follow-up for a couple years?
for physeal arrest or articular injury
True or false
better reduction is needed for older kids because there is less remodelling as they age.
true
Plastic deformation is unique to children’s bones. What is it?
bone bending or bowing, which makes reduciont difficult
Why is the perosteal sleeve particularly helpful in reduction for children’s fractures?
the periosteum is super thick in kids
WHat is remodelling? How is it carried out?
it’s the propensity of long bones to return to anatomic position with growth
osteoclasts and osteoblasts do this
more likely to happen in kids under about age 8 or 9
In what children/injuries will remodelling be helpful?
kids with 2 or more years of predicted growth
fractures near the bone ends - distal femur distal radius
deformity is in the plane of motion of the joint (this is why shoulders often remodel)
translation or bayonet position without shortening
When would remodeling not help?
in older children
displaced intraarticular fractures
malrotated fractures
fractures with angulation out of the plane of motion
these will need to be manually aligned
What are some important things to keep in mind when splinting a fracture?
you have to splint the joint above and below to completely immobilize
reduce the fracture before you splint it
immobilize it in such a way that the mechanism of injury is reversed
Would you pin a proximal humerus fracture in a young kid?
no
the shoulder joint has a broad range of mtion so it can be expected to remodel
When do you do surgery on a distal humerus fracture? WHy?
If it’s displaced at all it will require surgery because there is very little growth potential int he distal humerus and therefore isn’t likely to remodel
What is the main complication to be concerned about in distal humerus fractures?
neuropraxia
the radial, anterir interosseous and ulnar nerve all cross near the distal humerus
vascular injury is a concern too
Do distal radius fractures accept any angulation?
yes - quite a bit in children under ten (up to about 40 degrees)
and some small smoutn of angulation in those older than 10
What do we usually do with femur fractures these days?
Usually surgery for external fixation with flexible IM nailing or plating
the casting was just too much and people really don’t want to do any traction anymore
Why are distal femoral fractures worrisome?
they are most common in adolescents from valgus stress and frequently result in growth arrest even if they’re lined up perfectly
What is the main complication worry in proximal tibial fractures?
high incidence of vascular injury
Instead of tearing the ACL, kids will often get this injury….
avulsion of the tibial eminence
What is a patellar sleeve fracture?
the cartilagenous portion of the patella avulses
unique to children
requires open reduction but hard to diagnose
Who gets tibia fractures most often?
toddlers
