Pediatric Fractures

Question 1

True or false:

children get more fractures than adults with less trauma?

Answer 1

true

Question 2

when are fractures more concerning in kids than in adults?

Answer 2

when there’s physeal disruption (in 15% of fractures) that can lead to growth disrubances

Question 3

What two general types of fractures (related to pattern of fracture) are more common in kids than adults?

Answer 3

greenstick fractures and torus (buckling) fractures

Question 4

Where does more of the growth of the legs come from?

How about growth of the arm?

Answer 4

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

Question 5

Where do fractures typically occur in the epiphyseal plate (aka what layer)?

Answer 5

in the relatively weaker hypertrophic zone

Question 6

Which age group is more likely to get fractures trhough the growth plate?

which geneder and why?

Answer 6

teenagers

males because their growth plates are open longer

Question 7

Growth plate fracutres more often occur on the ___ end, except the _____.

Answer 7

the distal physis is more often involved except for the proximal humerus

Question 8

In general what is the salter-harris classifications of fractures?

Answer 8

1 : transverse fracture just proximal to the growth plate

2. longitudinal fracutrewhich splits part of thegrowth plate with the diaphysis - doesn’t cross the physis
3. fracture through the epiphysis involving the growth plate
4. fracture through the epiphysis and part of the diaphysis, involving the growth plate
5. crushing injury

Question 9

What are the 4 general treatment options for physeal fractures?

Answer 9

immobilization

closed reduciton

percutaneous fixation

internal fixation

Question 10

Why do Salter 3 and 4 fractures require perfect anatomic reduction?

Answer 10

because they are intraarticular

Question 11

Why do physeal fractures need close follow-up for a couple years?

Answer 11

for physeal arrest or articular injury

Question 12

True or false

better reduction is needed for older kids because there is less remodelling as they age.

Answer 12

true

Question 13

Plastic deformation is unique to children’s bones. What is it?

Answer 13

bone bending or bowing, which makes reduciont difficult

Question 14

Why is the perosteal sleeve particularly helpful in reduction for children’s fractures?

Answer 14

the periosteum is super thick in kids

Question 15

WHat is remodelling? How is it carried out?

Answer 15

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

Question 16

In what children/injuries will remodelling be helpful?

Answer 16

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

Question 17

When would remodeling not help?

Answer 17

in older children

displaced intraarticular fractures

malrotated fractures

fractures with angulation out of the plane of motion

these will need to be manually aligned

Question 18

What are some important things to keep in mind when splinting a fracture?

Answer 18

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

Question 19

Would you pin a proximal humerus fracture in a young kid?

Answer 19

no

the shoulder joint has a broad range of mtion so it can be expected to remodel

Question 20

When do you do surgery on a distal humerus fracture? WHy?

Answer 20

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

Question 21

What is the main complication to be concerned about in distal humerus fractures?

Answer 21

neuropraxia

the radial, anterir interosseous and ulnar nerve all cross near the distal humerus

vascular injury is a concern too

Question 22

Do distal radius fractures accept any angulation?

Answer 22

yes - quite a bit in children under ten (up to about 40 degrees)

and some small smoutn of angulation in those older than 10

Question 23

What do we usually do with femur fractures these days?

Answer 23

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

Question 24

Why are distal femoral fractures worrisome?

Answer 24

they are most common in adolescents from valgus stress and frequently result in growth arrest even if they’re lined up perfectly

Question 25

What is the main complication worry in proximal tibial fractures?

Answer 25

high incidence of vascular injury

Question 26

Instead of tearing the ACL, kids will often get this injury….

Answer 26

avulsion of the tibial eminence

Question 27

What is a patellar sleeve fracture?

Answer 27

the cartilagenous portion of the patella avulses

unique to children

requires open reduction but hard to diagnose

Question 28

Who gets tibia fractures most often?

Answer 28

toddlers