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PEDIATRIC FRACTURES:GENERAL CONCEPTS

JULIA RAWLINGS, MDSPORTS MEDICINE SYMPOSIUM: THE PEDIATRIC ATHLETE

2 MARCH 2018

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DISCLOSURE

• I have nothing to disclose.

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OBJECTIVES

• Review pediatric skeleton• Discuss pediatric fracture patterns• Discuss unique healing abilities of the

immature skeleton

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KIDS ARE NOT LITTLE ADULTS.

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THE PEDIATRIC SKELETON

• Growth plates are present• Active growth causes bones (including

growth plate) to be the weak link• Less calcified than adult bones• More porous• Fractures are common• Tendons & ligaments are stronger than

bones, so sprains & strains are very uncommon in young children

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THE PEDIATRIC SKELETON

• Thick periosteum– Mechanical stability – Rapid healing– Can make reductions difficult

• Higher remodeling potential– Younger children– Fracture near physis– Angulation in plane of motion of

joint– Rotational deformities do not

remodelhttps://www.partycity.com/group-costumes-skeleton 6

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ANATOMY REVIEW

• Epiphysis: Hard to see in young children prior to ossification

• Physis = growth plate• Metaphysis: Extensive

remodeling• Diaphysis: Less ability to

remodel• Apophysis: Bony outgrowth w/

separate ossification center where tendons attach

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PEDIATRIC FRACTURES

• Need less immobilization time• Less often require surgery• Non-union rare• Capable of plastic deformity

before failure• Comminuted fractures

uncommon• Less joint stiffness • Fractures involving the growth

plate can cause growth to accelerate or slow down

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MOST ACTIVE PHYSIS

• Proximal humerus• Distal radius• Distal femur• Proximal tibia

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THE PEDIATRIC HAND

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6 months 5 years 10 years

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THE PEDIATRIC ELBOW

• 6

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6 months 5 years 10 years

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THE PEDIATRIC KNEE

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6 years 10 years

3 years6 months

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PEDIATRIC-SPECIFIC FRACTURES

• Buckle (Torus)• Bowing (Plastic Deformity)• Greenstick• Fractures Involving the Growth Plate

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BUCKLE (TORUS) FRACTURE

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• Compression of metaphysis on one side of the bone

• Distal radius most common• Very stable

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BOWING

• Plastic deformity of long bone shaft

• Common in fibula & ulna• Limited ability to remodel• Requires reduction, sometimes

with completion of fracture (controversial)

• Sugartong or stirrup with posterior slab splint

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GREENSTICK

• Cortex disrupted on tension side; plastic deformity on compression side

• Diaphysis or diaphyseal-metaphyseal junction

• > 10º needs reduction• Often must complete

fracture to reduce, but this can lead to instability

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SALTER HARRIS CLASSIFICATION FOR PHYSEALINJURIES

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Fracture is worse when it involves the joint

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SALTER HARRIS I

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SALTER HARRIS II

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SALTER HARRIS III

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SALTER HARRIS IV

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SALTER HARRIS V

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GROWTH ARREST

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QUESTIONS???

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