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Pediatric Fractures: A developmental perspective

11/30/2016

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Pediatric Fractures:
  • Plastic deformity
  • Buckle (torus) fracture
  • Greenstick fracture - one side of cortex, not all the way through
  • Complete fracture
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​Toddler's Fracture ("Cast" fracture)
  • plant and twist -> spiral or oblique fracture of distal tibia with fibula intact
  • 9 month - 3 years old
  • occult in 13-43%
  • immobilize for 4 weeks


​
Salter-Harris Fractures
  • 15-30% of pediatric fractures
  • Most common - Type 2
  • SCIF is example of Type 1





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Complications
  • length discrepancy (goal <1-2cm difference at growth maturity)
    • growth arrest
    • growth acceleration
  • arthrosis
  • varus/valgus




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Elbow Fractures
  • Gartland grades (measure of displacement)
  • extension injuries are 60% of peds elbow fxs
  • vulnerable to vascular injuries, esp of brachial artery
  • nerve injuries
    • median 50%
    • radial 30%
    • ulnar - rare

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Alignment of elbow on x-ray
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Baumann's Angle
Apophyseal injuries
  • apophysis - a natrual protuberance of bone, such as the epicondyle
  • this can include avulsion inuries of insertion points, such as tibial tuberosity from patellar tendon avulsion

Splint and cast complications
  • compartment syndrome
  • pressure sores
  • nerve palsy

Bone Cysts
  • unicameral cysts
    • 5-15 months
  • aneurysmal cysts
  • can lead to pathologic fractures
Non-Accidental Trauma
  • 80% of femur fractures in children under walking age are due to abuse
  • Bucket handle fractures
  • rotary shear force causing transepiphyseal fractures
Note: Some of the top malpractice missed diagnoses are orthopedic.
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  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map