Paediatric 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
| 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