Pediatric Orthopedic Fractures Flashcards
Pediatric Considerations
Growing individual
- All systems, not just musculoskeletal
Periods of change
- Infants through adolescence
- Skeletal maturation vs. sexual maturation
Societal and environmental
Pediatric skeletal properties
- Periosteum (Thicker, stronger, more osteogenic; Faster and bigger callous formation)
Pediatric Musculoskeletal System
Bones tend to bend, rather than break
Ligaments and tendons stronger in young
Weakness where metaphysis meets physis/growth plate
Physeal injury can disrupt bone growth
Apophysis - Physis primarily exposed to tensile force, rather than compressive force
Pediatric Fracture Types
Torus or buckle - one side bends, raising a buckle
Bowing (Fibula or ulna common) - Plastic deformation without a fracture line
Greenstick - Cortex on tension side disrupted, Cortex on compression side intact
Complete (Spiral, Oblique, Transverse)
Epiphyseal - Salter Harris classifications, Type 2 most common, Growth arrest can happen with any
Apophyseal avulsion
Occult Fracture
Difficulty identifying site of pain
Family may not have observed trauma or atraumatic etiology
May have limpness and swelling but negative radiographic findings for 2–3 weeks
Toddler’s Fracture
Distal tibia spiral fracture, typically non-displaced
Ambulatory children, up to 5–6 years of age (commonly 2–6 years old)
Etiology may be due to a fall onto an
extended leg
Clavicle Fracture
Neonatal
Toddlers - typically splinted, figure of eight wrap
Non-Accidental Trauma (NAT)
Spiral fractures (long bones)
Rib fractures
Skull/TBI and abusive head trauma
Sternal fracture
Scapular fractures
Fractures are the second most common injury caused by child physical abuse (bruises are first)
Mandated reporting by health care providers in the United States
When is a Fracture Suspicious for Child Abuse?
No history of injury
History of injury not plausible—mechanism described not consistent with the type of fracture, the energy load needed to cause the fracture, or the severity of the injury
Inconsistent histories or changing histories provided by caregiver
Fracture in a non-ambulatory child
Fracture of high specificity for child abuse (e.g., rib fractures)
Multiple fractures
Fractures of different ages
Other injuries suspicious for child abuse
Delay in seeking care for an injury
Trampoline Fracture
Proximal tibial metaphysis
Transverse and usually non-displaced
Due to a second force from another, typically larger, person on the trampoline
Slipped capital femoral epiphysis (SCFE)
Proximal femoral growth plate instability: Salter–
Harris type I
Surgical Pinning
Pediatric Avulsion Fractures
Tibial tuberosity associated with prior diagnosis of
Osgood-Schlatter disease
Patellar fracture associated with prior Sinding-Larsen-
Johansson lesion or differential diagnosis with stress
fracture
Pathological Fractures
Cancer
Metabolic or neuromuscular syndromes
Osteogenesis imperfecta
Spica Casting
Femur fracture in infants and toddlers
More commonly in children with hip dysplasia
Titanium Elastic Intramedullary Nails
Frequently used for midshaft and distal femur
Sometimes used in tibia if it requires internal fixation
Caution in heavier and older patients
May decrease puncture risk of opposite cortex compared to steel nails
Increased cost compared to stainless steel, with relatively comparable outcome in some long bone
Inpatient Rehabilitation
Tend to be multi trauma, bilateral fractures, baseline impairment in mobility or associated brain injury
Also admitted for external fixator family training
Goal depends on timing
