the new topic are my channal pediatric fracture

1. Mr.Satish Rinhayat
Assist. Prof. (M.P.U.)

2. • Fractures in children are different from those in adults, mostly because of
some anatomical and physiological differences between a child's and an adult's
bone.
• Some of these are discussed below:
1. Growing skeleton
2. Springy bones
3. Loose periosteum
4. Site of fractures
5. Healing of fractures
6. Remodelling

3.  Fractures in children can be conveniently considered under four
headings:
1. birth fractures and related injuries
2. epiphyseal injuries
3. fractures of shafts of long bones in older children
4. pathological fractures.

4.  Three types of fractures may occur in a newborn.
 These are as follows:
1. Fracture or epiphyseal separation sustained during a difficult delivery
2. Multiple fractures associated with the congenital fragility of bones e.g.,
osteogenesis imperfecta
3. Pseudoarthrosis of tibia

5.  This is a group of injuries seen in a growing skeleton.
 An injury involving the growth plate may result in deformities due to irregular
growth.
 Shortening may occur because of premature epiphyseal closure.
 Salter and Harris classification
 Epiphyseal injuries have been classified into 5 types based on their X-ray
appearance. The higher the classification, the more severe the injury. The
incidence of growth disturbance is common in types III, IV and V

7.  Although, fractures of the shaft of long bones have many similarities in
children and adults, the following are some of the features peculiar to
children:
1. Displacement is less - greenstick fractures
2. Alignment: Perfect, end-to-end alignment is not mandatory.Some amount
of mal-alignment is corrected with growth.
3. Union: Fractures unite faster in children.
4. Treatment - conservative methods.

9.  These are uncommon in children.
 However, there are some diseases which are particularly common in
children and result in pathological fractures.
 These are:
1. fractures through infected bones
2. fractures through cysts
3. fractures associated with osteogenesis imperfecta.

10.  Diagnosis of fractures in children is often missed for the following reasons:
1. History of trauma is either concealed, or the child is not old enough to
communicate.
2. The more dramatic signs of fracture may be absent, especially in incomplete
fractures. Thus, there may be no deformity, no abnormal mobility, no crepitus
etc.
3. Parents may attempt to conceal the fact that an infant has been injured,
especially when there has been abuse (battered baby syndrome).
4. Undisplaced fractures are often missed on X-ray, unless carefully looked for.

11. • Therefore, irrespective of the history, possibility of an injury should always
be considered whenever marked loss of function, pain and tenderness, and
unwillingness to use a limb occurs in children.
• On the other hand, trauma may be falsely implicated as a cause, in some
non-traumatic diseases; the episode of trauma being often days or weeks
earlier.

12.  Most fractures in children can be successfully treated by non-operative
methods like plaster immobilisation, traction, sling etc.
 Operative intervention is necessary in some fractures
 availabilityofimageintensifierand development of percutaneous methods of
fixation

13.  Fractures in children are associated with few complications.
 Union of a fracture is generally not a problem; non-union being very rare.
 Some complications relatively important in children's fractures are:
1. Growth disturbances in epiphyseal injuries.
2. Brachial artery injury in supracondylar fracture of the humerus.
3. Myositis ossificans in injuries around the elbow.
4. Avascular necrosis in fracture of the neck of the femur.

14.  True or false
1. Distal radius and ulna are the most common fracture locations in children followed by the
clavicle.
2. Most common bone fractured during birth is the clavicle.

15. References
Essential Orthopaedics (Including Clinical Methods) FIFTH EDITION J.
Maheshwari MS Orth (AIIMS)