FRACTURE IN CHILDREN

(DIAGNOSIS AND TREATMENT)

BY:- ANUBHA KANDPAL

DIFFERENCE IN BONES OF CHILD
DIAGNOSIS
 DIAGNOSIS IN CHILDREN ARE OFTENLY MISSED FOR
FOLLOWING REASONS:-
 HISTORY OF TRAUMA IS EITHER CONCEALED OR CHILD IS NOT OLD
ENOUGH TO COMMUNICATE.
 MORE DRAMATIC SIGNS OF FRACTURE MAYBE ABSENT;ESPECIALLY IN
INCOMPLETE FRACTURE – there is no deformity , no abnormal motility , no crepitus.
 PARENTS MAY ATTEMPTS TO HIDE THAT INFANT HAS BEEN INJURED
SPECIALLY WHEN THERE IS ABUSE(BATTERED BABY SYNDROME).
 UNDISPLACED FRACTURES ARE OFTENLY MISSED , UNLESS CAREFULLY
LOOKED FOR
THEREFORE IRRESPECTIVE OF HISTORY,
POSSIBILITY OF FRACTURES SHOULD ALWAYS
BE CONSIDERED WHENEVER LOSS OF
FUNCTION,
PAIN,TENDERNESS,UNWILLINGNESS TO USE A
LIMB OCCURS IN CHILDREN

ON THE OTHER HAND,TRAUMA MAY BE FALSELY IMPLICATED AS

A CAUSE, IN SOME NON TRAUMATIC CAUSES,THE EPISODE OF
TRAUMA BEING DAYS OR WEEKS EARLIER
PRINCIPLE OF MANAGEMENT

 MOSTLY CONSERVATIVE – CLOSED

REDUCTION AND CAST
IMMOBILIZATION,TRACTION AND SLING.
 OPENREDUCTION AND INTERNAL
FIXATION.
METHODS OF FIXATION
MOST COMMONLY USED METHOD
(CAST)
SLING FIXATION
K-WIRE FIXATION

@ DISTAL RADIAL
METAPHYSEAL
FRACTURE
INTRAMEDULLARY K-WIRE
FIXATION:-

VERY USEFUL IN
DIAPHYSEAL
FRACTURES
SCREW FIXATION

@ HIP JOINT
IN FRACTURE
NECK OF
FEMUR
PLATES AND SCREWS

USED IN
MULTIPLE
TRAUMA
IMN NAILING

USED ONLY IN
ADOLESCENCE
DUE TO HIGH
CHANCES OF
GROWTH
DISTURBANCES
EXTERNAL FIXATION

USED IN CASES OF
OPEN FRACTURE
INDICATIONS OF OPERATIVE
MANAGEMENT
DISPLACED INTRA ARTICULAR FRACTURE
(SALTER HARRIS TYPE 3;4)
FRACTURES WITH VASCULAR INJURY
COMPARTMENT SYNDROME
FRACTURES NOT REDUCED BY CLOSED REDUCTION-
(SOFT TISSUE INTERPOSITION ; BUTTON HOLING OF PERIOSTIUM)
OPERATIVE INTERVENTION IS
NECESSARY IN:-

 # OF NECK OF FEMUR,DISPLACED
 # OF SHAFT OF FEMUR, IN AN ADOLESCENT
 # LATERAL CONDYLE OF HUMERUS(TYPE 4 EPIPHYSEAL INJURY)
WITH AVAILABILITY OFIMAGE
INTENSIFIER AND DEVELOPMENT OF P/C
METHODS OF FIXATION,OPERATIVE
FIXATION OF UNSTABLE FRACTURES IN
CHILDREN USING TENS NAILS AND RUSH
NAILS HAS BECOME POPULAR
THIS MAKES TREATMENT OF UNSTABLE
FRACTURES MORE PREDICTABLE
COMPLICATIONS

ASSOCIATED WITH FEW COMPLICATIONS:-

UNION OF FRACTURE IS GENERALLY NOT A PROBLEM
NON-UNION IS VERY RARE

SOME COMPLICATIONS RELATIVELY IMPORTANT ARE:-

GROWTH DISTURBANCES IN EPIPHYSEAL INJURIES
BRACHIAL ARTERY INJURY IN SUPRACONDYLAR FRACTURES
MYOSITIS OSSIFICANS IN INJURIES AROUND ELBOW
AVN IN FRACTURES OF NECK OF THE FEMUR
THANK YOU