Basic presentation for a begineer in Orthopedics surgery & traumatology

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FRACTURES IN
PAEDIATRIC
AGE GROUP
DR. MUHAMMAD MUNEEB
Medical Officer
Department of Orthopaedics & Traumatology, IHT

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EPIDEMIOLOGY
 Leading cause of death in children is accidental trauma
 Skeletal trauma accounts for 10% to 15% of all childhood
injuries
 42% of boys will sustain at least 1 fracture in their childhood
compared with 27% of girls (Boys to girls ratio is 3:1)
 Open fractures are rare (<5%)

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CHILDREN ARE SPECIAL
 They have different ANATOMY & PHYSIOLOGY
1. Growth plate
2. Bone
3. Cartilage
4. Periosteum
5. Ligaments

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MECHANISM OF INJURY
 Bones tend to BOW rather than BREAK
1. Compressive force causes TORUS FRACTURE aka
BUCKLE FRACTURE
2. Force to side of bone may cause Break in only ONE
CORTEX causing GREENSTICK FRACTURE
(Other cortex only bends)
3. In very young children, NEITHER CORTEX may
break causing PLASTIC DEFORMITY

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TORUS VS GREENSTICK FRACTURE

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PLASTIC DEFORMITY

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INJURY PATTERN
 Point at which METAPHYSIS CONNECTS TO
EPIPHYSIS is an anatomic point of weakness
 Ligaments & Tendons are stronger than bone
 PERIOSTEUM is biologically active & Often stays
intact with injury Which STABILISES FRACTURE &
PROMOTES HEALING

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PHYSEAL INJURY
 Contributes to 20% of all Skeletal injuries
 Can disrupt growth of bone
 Injury near but not at the physis can stimulate bone to
grow more
 Phalanx fractures are the most common physeal
injury

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SALTER HARRIS CLASSIFICATION OF
GROWTH PLATE INJURIES
 Used to delineate risk of growth disturbance
 Types I to V
 Higher grade fractures are more likely to cause
growth disturbances, although it can happen with any
physeal injury

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TYPE I
 Transverse fracture through the physis separating
epiphysis from metaphysis
 Incidence 6%

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TYPE II
 A fracture through the growth plate & metaphysis sparing the
epiphysis (producing a chip/ triangular piece of metaphysis)
 Most common, Incidence: 75%
 Takes 2-3 weeks to heal

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TYPE III
 A physeal fracture that extends through the
epiphysis exiting at joint space, sparing the
metaphysis
 Incidence: 8%

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TYPE IV
 A physeal fracture plus epiphyseal & metaphyseal fracture
 Incidence: 10%

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TYPE V
 A compression fracture of the growth plate
 Resulting in a decreased space between the
epiphysis & the diaphysis on x-ray
 Incidence: 1%

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POWER OF REMODELING
 Can accept more angulation & displacement
 Factors affecting remodeling potential are
1. Years of remaining growth
2. Position in the bone
3. Plane of motion
4. Physeal status

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ITS GOOD TO BE YOUNG
 Fractures in children tend to heal faster than adults
 Require shorter immobilization time
 Children don’t tend to get as stiff as adults after
immobilization

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PRINCIPLES OF MANAGEMENT
 Mostly conservative, Closed Reduction & cast
immobilization
 Open Reduction & Internal Fixation

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INDICATION FOR OPERATION
 Displaced intra-articular fractures
 Fractures with vascular injury
 Compartment Syndrome
 Fractures not reduced by closed reduction

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METHOD OF FIXATION
1. K-wires
 most common
 Metaphyseal fractures

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METHOD OF FIXATION
 Intramedullary Wires
 Elastic Nails
 Very useful
 Diaphyseal fractures

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METHOD OF FIXATION
 Screws
 Plates & Screws

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METHOD OF FIXATION
 Intramedullary Nailing
 Chances of growth disturbances
 In adolescents only

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METHOD OF FIXATION
 External Fixation
 For open fractures

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COMPLICATIONS
 Malunion (unusual)
 Nonunion (Hardly seen)
 Growth disturbance (with Physeal damage)
 Vascular (Volkman’s Ischemia)
 Infection (open fractures)

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BATTERED BABY SYNDROME
 Soft tissue Injuries (bruising & burns)
 Intra-abdominal Injuries
 Intra-cranial Injuries
 Delay in seeking treatment
 Fractures at different stages of healing

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PATHOLOGICAL FRACTURES
 Metabolic disorders
 Chronic infections
 Benign bone tumors
 Malignancy
 Congenital diseases

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