Pediatric Musculoskeletal Injuries Flashcards
How do children’s bones differ from adult bones? What kinds of injury does this lead to?
children’s bones are more porous and pliable, which results in a greater number of incomplete fractures - due to decreased mineral content and responds to forces differently resulting in unique fracture patterns
ligaments are also relatively stronger and less likely to get injured, making younger children more likely to experience fractures than sprains or dislocations
What are the four anatomic aresa of pediatric long bones?
epiphysis
physis (growth plate)
metaphysis
diaphysis
What are the structural differences in pediatric bones?
periosteum is thick, strong, and metabolically active, holds fracture fragments in alignment and aids in reduction, healing and remodeling
extensive remodeling corrects large degrees of angulation and displacement (age < 8 yrs)
nonunion is rare
Salter-Harris Classification system
used to describe the location of a fracture in relation to the growth plate
fractures are graded as a scale from 1 to 5, with a higher classification indicating an increased risk for affecting further bone growth
type I Salter-Harris Physeal injury
separation through the physis, usually through areas of hypertrophic and degenerating cartilage cell columns
radiograph appears normally initially
diagnosed based on injury (usually shear injury), swelling, pain, and tenderness over growth plate
growth is rarely affected
type II Salter-Harris Physeal injury
fracture through a portion of the physis that extends through the metaphyses
most common fracture pattern involving growth plate
most common fracture pattern involving growth plate
type III Salter-Harris Physeal injury
fracture through a portion of the physis that extends through the epiphysis and into the joint
may interfere with growth
involves articular surface, may affect joint
type IV Salter-Harris Physeal injury
fracture across the metaphysis, physis, and epiphysis
may interfere with growth
involves articular surface, may affect joint
type V Salter-Harris Physeal Injury
crush injury to the physis/growth plate
from severe axial loading
worst prognosis with possible growth arrest
What details should be included when describing fractures?
the bone involved
the location within the bone
the fracture pattern
any displacement
age of the fracture
Does it take more force to cause a transverse fracture, spiral fracture, or spiral fracture?
transverse fracture
transverse fracture
perpendicular to long axis
complete fracture
usually higher force mechanism
direct blow or bending force
often easy to reduce
comminuted fracture
when the bone fractures in multiple places
usually takes a great amount of force
rare in young children and difficult to reduce
often require operative intervention fixation
oblique fracture
oblique to long axis of bone
twisting force or compression/bending mechanism
can have significant displacement, may be difficult to maintain alignment when reduced
spiral fracture
caused by a twisting mechanism
often takes less force than transverse fracture