Fractures in Children

Fractures in Children

Characteristics of Children’s Bones Compared to Adults:

• Thick articular cartilage: This makes X-ray images less clear.

• Thick periosteum: Helps bones heal quickly.

• High collagen content: Makes bones more prone to fractures.

• More cancellous bone: Results in simple fracture patterns.

• Growth plate: Allows for correction of bone deformities.

• Stronger ligaments: Makes fractures more likely to occur before ligament damage.

Reasons Why Children’s Bones Heal Faster:

• Thick periosteum

Reasons Why Children’s Bones are More Prone to Fractures:

• High collagen content

Simple Fracture Patterns Due to:

• More cancellous bone

Correction of Deformities Through:

• Growth plate

Fracture Before Ligament Damage Due to:

• Stronger ligaments

The Role of the Growth Plate:

• Growth and ease of correction of fracture angles.

Characteristics of Children’s Bones:

• Higher collagen to bone ratio.

• More cells and uneven density, resulting in:

• Reduced tensile strength and comminution.

• Less fragmentation.

• Bones are injured by both tension and compression mechanisms, explaining the occurrence of buckle fractures in children.

• Bones are more easily displaced.

Characteristics of Children’s Periosteum:

• More active metabolism than adults, resulting in:

• Increased callus formation, bone healing, and remodeling potential.

• Thicker and stronger.

Fracture Location Based on Age:

• Infants: Bone shaft

• Adolescents: Metaphysis, both epicondyles

• Adults: Epiphysis

Characteristics of Children’s Cartilage:

• Increased cartilage proportion, improving flexibility.

Classification of Growth Plate Injuries According to Harris Salter:

• Harris Salter Type I: Growth plate separation without traversing the growth plate, no effect on growth (simple physeal separation).

• Harris Salter Type II: Partial growth plate separation + a bone fragment towards the shaft (separation + fracture).

• Harris Salter Type III: Partial growth plate separation, fracture line crosses the growth plate (partial epiphyseal separation).

• Harris Salter Type IV: Fracture crossing the growth plate, fracture through the metaphysis.

• Harris Salter Type V: Crush injury from the epiphysis, no visible fracture line on X-ray, only diagnosed with sequelae (rare).

1% of Growth Plate Injuries Result in:

• Salter-Harris fractures

Characteristics of Salter-Harris Fractures:

• Less than 10% may spontaneously resolve.

• Salter-Harris fractures are more prone to destruction in children than in adults, resulting in:

• “Fishtail” deformity, causing growth retardation rather than growth arrest.

Mechanism of Salter-Harris Fracture Formation:

• Significant trauma impacting the growth plate or fractures traversing the growth plate.

Bone Remodeling in Children:

• Bone apposition: Bone on the concave side.

• Bone resorption: Bone on the convex side.

• Asymmetry of growth and remodeling require growth plate activity at the epiphysis and intact periosteum.

Treatment of 5 Harris Salter Types:

• Type I, II, III: Conservative management.

• Type IV, V: Small Kirschner wires for fixation.

Most Sensitive Part of the Long Bone Epiphysis:

• Anterior aspect of the proximal tibial epiphysis.

Epidemiology of Fractures in Children:

• Males > females.