Paediatric Fractures & Trauma

Trauma Principles

  • Bone in a child is more porous with less mineral content, leading to the possibility of plastic deformation
  • Periosteum is thick & usually intact on the compression side of fracture
  • Fractures heal faster, non union unlikely
  • Remodelling happens best at the end of bone in the plane of motion
  • Paediatric fractures are those which occur with open physes regardless of age
  • Ligamentous injuries are unusual as the ligaments are stronger than open physes

Specific Fracture Patterns

  • Buckle or Torus
    • Metaphyseal fracture
    • Compression side has undergone plastic deformation
  • Greenstick Fracture
    • Diaphyseal injury
    • Compression side fails & undergoes plastic deformation rather than a complete fracture
    • Tenson side fails as complete fracture

Growth Plate

  • Physis
    • Injury tends to occur in the adolescent
    • ~20 % of fractures involve the physis
    • physis is stabilized by the perichondral ring & the internal undulations of the growth plate
  • Epiphysis
    Germinal layer
    Maturation layer
    Zone of hypertrophy
    Zone of provisional calcification
    Metaphysis

Classification - Salter Harris

Salter Harris Classification
Type Description
1 through the physis
2 through the physis & extension to the metaphysis
3 through the joint & then along the physis
4 through the joint & then through the metaphysis
5 compression injury to the physis
6 perichondylar ring injury

Arrest Patterns

  • peripheral – angular problem
  • central
  • linear / combined

Treatment of Growth Arrest

  • get CT scan or MRI
    • map out how big & where
  • if < 50% consider excision & interposition of fat
  • other options include
    • complete the growth arrest for angular
    • contralateral epiphysiodesis
    • osteotomy
  • peripheral bars are approached directly
  • central bars are approached via a metaphyseal window

 

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