Pediatric Fractures Flashcards
Kid Bones unique features
● Increased elasticity of the bone
○ Bones bend but may not break
○ eg. Torus and greenstick
● Thicker periosteum- more stable
reduction
● Typically do not need surgery
○ Closed reduction and cast sufficient
● Quicker healing leads to reduced
complication of long immobilization
Mechanism of Injury for fractures if <3 yoa
● Fractures unusual in kids younger than 3 yo
○ Given natural limits, young kids typically don’t get fractures
○ Watch for abuse, or simply inappropriate play
Imaging for kids fractures
● May need to image the entire extremity
● Consider bilateral comparison
○ Growth plate injuries may need comparison
● AP, Lateral, Oblique and specialized views can be used
● Watch for soft tissue edema and periosteum
● May show midshaft, or metaphysis
● Assess for dislocation and joint alignment
Bone Remodeling for kids fractures
● Children rapidly heal
● To a certain degree, angulation can self correct
● Intra-articular and rotational deformities usually do not correct
● Greatest remodeling potential in younger children, who have greater extent
of future growth
Salter-harris correction depends on:
- Extent of angulation
- Age > 10 years old as less growth remodeling
potential - Remodeling requires 1-2 years of growth
remaining - Avoid repeated attempts at reduction
What is Growth Arrest?
● Growth arrest after a physis injury is a
main concern
● Interrupted bone lengthening
● Bone bridge (or physeal bar) can form
3 months post-injury. Continue
follow-up for 1 year required
● Risk factors
○ Multiple attempts at reduction
○ Reduction after 5 days
Buckle Fracture
● Also called Torus fracture
● Typically uncomplicated
● Evaluate the growth plate
● Good remodeling potential if younger
then 10
● Manipulation and reduction depends
on age, angulation
● Often sugar tong splint with transition
to short arm cast can be used
Greenstick Fracture
● Broke one cortex, but not the other
● May need to complete the fracture of
the intact cortex to achieve good bone
alignment
● Long arm splint/ cast
Colles Fracture
● FOOSH
● This fracture would
need reduction
● Long arm splint/cast
with transition to short
arm cast
Bowing Fracture
● Plastic deformation
● Debate about reduction vs
expectations for remodeling
● < 20 angulation can remodel
● Permanent deformation is possible
● Long arm splint/ cast
Humeral Fracture
● Humeral head ossification at 6 months
● Greater tuberosity from 1 to 3 yrs
● Supracondylar fracture most common
of the elbow
● 5-8 yrs old after which dislocation is
more common
● FOOSH
Elbow development during childhood
○ Bone structures at the elbow develop
within multiple cartilaginous
ossification centers. Typically there is
ossification in the following order:
■ Capitulum
■ Radial Head
■ Medial epicondyle (Internal)
■ Trochlea
■ Olecranon
■ Lateral epicondyle
Elbow Fracture
● Supracondylar fracture
● Most common elbow fracture in
children
● Nondisplaced- Long arm splint/cast
● Displaced - Surgery w/ pins or ORIF
Supracondylar Fracture
- Example of a more
significant injury - Required closed reduction
with percutaneous pins - Pins placed through the
skin using fluoroscopy
Medial epicondyle fracture
● Displaced medial epicondyle fracture
● Nondisplaced- Long arm splint/cast
● Displaced - ORIF
