Pediatric Fractures: A developmental perspective

Pediatric Fractures:

• Plastic deformity
• Buckle (torus) fracture
• Greenstick fracture - one side of cortex, not all the way through
• Complete fracture

​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

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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

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.