FRACTURES IN CHILDREN

Frequency of Fractures in Children

Source: James H. Beaty, James R. Kasser: Rockwood and Wilkins Fractures in Children 5th Edition. Lippincott Williams and Wilkins p.10

Incidence of Specific Fractures

Source: James H. Beaty, James R. Kasser: Rockwood and Wilkins Fractures in Children 5th Edition. Lippincott Williams and Wilkins p.12

Zone of Hypertrophy

Maximum germination activity occurs here

Must-know Fractures
Elbow
Supracondylar Lateral Condylar

Forearm
Distal Radius Monteggia Galleazzi

Elbow Fractures
History Symptoms Signs
Post-traumatic Inconsolable crying Acute localised pain Any obvious deformity Tenderness Bruises Swelling Limited movement

Radiological Features
At least 2 views Obvious fracture Fat pad signs
Anterior fat pad sign Posterior fat pad sign

Lateral landmarks
Anterior humeral line Shaft-Condylar Line

Fat Pad Signs of Elbow

Posterior fat pad sign is the MOST reliable

Lateral Landmarks
Seen on a lateral film

Shaft-Condylar Angle

Anterior humeral line

Supracondylar Fracture
Incidence Mechanism of Injury Classification Management Complications

Supracondylar Fracture Incidence

3rd most common fracture in children and most common elbow fracture Peak age is 4-7years Hyperflexibility predisposition

Supracondylar Fracture Mechanism of Injury

Falling on a hyperextended hand

Supracondylar Fracture Gartland Classification

Supracondylar Fracture Gartland Classification

Type I

Type II

Type III

Supracondylar Fracture Management

Classification Implications Type I Undisplaced, periosteum intact with significant inherent stability of the fracture Displaced, with an intact posterior cortex Management Simple immobilization with a cast applied at 90o elbow flexion M&R (K wires) followed by (i) Immobilization with a cast applied at 90o elbow flexion (ii) Insertion of 2 lateral pins M&R followed by insertion of 2 crossed pins

Type II

Type III

Periosteum completely torn, no cortical contact

Supracondylar Fracture Management

Cast Immobilization at 90o Flexion

Insertion of Crossed Pins Insertion of 2 Lateral Pins

Supracondylar Fracture Complications

Cubitus Varus Deformity

Brachial Artery Injury Neurological Deficit Compartment Syndrome

Supracondylar Fracture Complications

Compartment Syndrome Elbow Stiffness Myositis Ossificans

Non-union AVN of the trochlear

Types of Fractures
Torus Metaphyseal Physeal Greenstick Others
Monteggia Galleazzi

Torus Fracture

Greenstick fracture

Physeal fractures
Fractures involving the physis.

Salter-Harris Classification
Types I-V

Salter-Harris Classification
Guides management
Type I & II III & IV V Management Conservative Operative Expectant

Take Home Message

Most common fracture in children is at the distal radius and physis. Must-know fractures include the supracondylar though it is the 3rd most common fracture. Physeal fractures classified under Salter-Harris