FRACTURES IN CHILDHOOD

Pediatric fractures differ from adult fractures on following counts:

1. Tendency for angular/green-stick fractures due to relatively pliable bones,

2. Less risk of displacement due to thicker and stronger periosteum, though it also impedes closed reduction,

3.

4. Higher capacity for remodeling that obviates the need for strict re-alignment, and

5. Tendency for overgrowth deformities in affected limbs due to excessive callous formation.

Types: Pediatric fractures may be broadly divided into non-epiphyseal and epiphyseal fractures.

Non-epiphyseal fractures are more common and include many variants, e.g. (a) complete fractures involving both sides of bone, (b) buckle or torus fractures due to sudden bone compression, (c) Green-stick fractures with angulation beyond the limits of plastic deformation, and (d) bowing or bend deformities within the limits of plastic deformation, but without fracture.

Epiphyseal fractures account for 10-20% of all frac­tures with peak incidence in adolescence. These fractures are more common in upper extremities, commonest being distal radius followed by distal tibia. Sudden traction of ligaments which attach over epiphysis and relative weakness of perichondrial ring are two important contributory factors for epiphyseal fractures. According to Salter and Harris classification, epiphyseal fractures are classified into 5 types:

1. Simple epiphyseal separation from the physis,

2. Fracture involving physis and metaphysis,

3. Fracture involving physis and epiphysis,

4. Extended fracture involving physis, epiphysis and metaphysis and

5. Crush injury to physis

Management: Though detailed discussion of the fracture-treatment is beyond the scope of this book, some general principles are as follows:

• Most non-epiphyseal fractures heal excellently with simple immobilization for 2-3 weeks.

• Type I and II epiphyseal fractures need closed reduction but perfect alignment is unnecessary except in type II fracture of distal femur.

• Type III and IV fractures need perfect alignment with internal or external fixation.

Common indications for internal fixation are:

(a) displaced epiphyseal or intra-articular fractures,

(b) unstable fractures, (c) multiple or open fractures. External fixation is usually used for pelvic fractures or in cases with severe tissue/neurovascular injury.

BIBLIOGRAPHY

1. Sahetiya A et al. Developmental dysplasia of Hip. Standard treatment guidelines. Indian Academy of Pediatrics. 2022.

2. Kalluraya S et al. CTEV and flat foot. Standard treatment guidelines. Indian Academy of Pediatrics. 2022.

3. Sriram V et al. Pulled elbow Standard treatment guidelines. Indian Academy of Pediatrics. 2022.

4. Mondal R et al. Growing pains. Standard treatment guide­lines. Indian Academy of Pediatrics. 2022.