FRACTURES IN

CHILDREN
OUTLINE
• RELEVANT ANATOMY
• TYPES OF FRACTURES
• DIAGNOSIS
• PRINCIPLE OF MANAGEMENT
• COMPLICATION
RELEVANT ANATOMY
• Children have different physiology and anatomy
of their bones compared to adult
a. Growth plate
b. Bone
c. Periosteum
d. Cartilage
e. Ligaments
f. Remodelling
RELEVANT ANATOMY
 PATTERN OF FRCATURES
a. Incomplete
• Greenstick fracture
• Torus (buckle) fracture
• Deformation
b. Complete
 TYPES OF FRACTURES
a. Birth fractures and related injuries
b. Fractures of shaft of long bones in older children
c. Pathological fractures
d. Epiphyseal injury
 A.BIRTH FRACTURES
Fracture sustained during a difficult delivery
• Clavicle fracture is most common.
• Others are fracture of the shaft of the humerus,
femoral fracture.
• Simple strapping of the fracture may be
sufficient.
• Union occurs rapidly.
 B.FRACTURES OF SHAFT OF LONG
BONES IN OLDER CHILDREN
These fractures have many similarities
in children and adults, but the following
are some of the features peculiar to
children.
• Displacement is less; e.g. greenstick
fractures
• Alignment: Perfect, end-to-end
alignment is not mandatory. Some
amount of ‘mal-alignment’ is corrected
with growth
 C.PATHOLOGICAL FRACTURES
These are uncommon in children. However, there
are some diseases which are particularly common
in children and result in pathological fractures.
These are:
(i) fractures through infected bones
(ii) fractures through cysts
(iii)fractures associated with osteogenesis
imperfecta
 D.EPIHYSEAL INJURY
• Consist 20% of skeletal injuries
• Can disrupt growth of bone and results to
deformities.
• Shortening may occur because of premature
epiphyseal plate.
SALTER HARRIS CLASSIFICATION
• It delineate the risk of growth disturbance
• It has grade 1 up to 5
• Growth disturbance can happen with ANY grades
• Higher grades fractures are more likely to cause
growth disturbance.
SALTER HARRIS CLASSIFICATION
FRACTURES COMMON IN PEDIATRIC
a. Forearm bones fractures
b. Supracondylar fracture of humerus
c. Fracture of lateral condyle of the humerus
d. Epiphyseal injuries
e. Spiral fracture of tibial shaft
 PRINCIPLE OF MANAGEMENT
A.NON OPERATIVE
• Fractures in children heal faster.
• Fractures close to the joint heal faster.
• Sideways displacement will remodel.
• Angulation in the plane of the adjacent joint is
acceptable.
• Rotational mal-alignment will never remodel.
• Physis subjected to compressive forces inhibits growth
 PRINCIPLE OF MANAGEMENT
B. Operative intervention(Open reduction and
internal fixation); Indicated in the following
fractures .
• Displacement intra articular fractures
• Fractures with vascular injury
• Fractures not reduced by closed reduction
 METHODS OF FIXATION
• Casting-commonest
• K-wires –metaphyseal fractures
• Intramedullary wires /elastic nails-
diaphyseal fractures
• Screws
• Plates
• IMN-adolescents
• External fixator
 COMPLICATION
• Growth disturbances in epiphyseal injuries
• Brachial artery injury in supracondylar fracture of
the humerus.
• Myositis ossificans in injuries around the elbow.
CLAVICLE FRACTURE
Most caused by
• Birth injury
• Fall on outstretched hand
• Heals well conservatively
• No functional problems
• Treatment:
• Sling or figure of 8
bandage
 SUPRACONDYLAR HUMERUS
• The fracture is caused by a fall on an out-stretched
hand.
• it can be extension type or flexion
 SUPRACONDYLAR FRACTURE
Gartland classification
 SUPRACONDYLAR FRACTURE
Clinical features
• Pain
• Refusal to move the elbow
O/E ;
• Inspection Gross deformity
• Swelling
• Echymosis in antecubital fossa
• Motion ; limited ROM
 SUPRACONDYLAR FRACTURES
Imaging
• AP and lateral x ray of the elbow
• Findings : posterior fat pad sign
• Displacement of anterior humeral line
• Alteration of baumann angle
 SUPRACONDYLAR FRACTURES
• Fat pad sign

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 SUPRACONDYLAR FRACTURES
Anterior humeral line

Normal Abnormal
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 SUPRACONDYLAR FRACTURE
Management
a. Non operative
Long arm casting with < 90 of elbow flexion
b. Operative
• type 2 and 3 supracondylar fractures
• Flexion type
1.CRPP
2.Open reduction +percutaneous pinning
 SUPRACONDYLAR FRACTURES
Needs immediate care
• Nerve injury: Median N,
Radial N
• Vascular injury: Brachial
artery
• Swelling: compartment
syndrome
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