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

• Post-traumatic• Inconsolable crying

• Symptoms • Acute localised pain

• Signs• 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 FractureIncidence

• 3rd most common fracture in children and most common elbow fracture

• Peak age is 4-7years• Hyperflexibility predisposition

Mechanism of Injury• Falling on a hyperextended hand

Supracondylar Fracture

Supracondylar FractureGartland Classification

Type I Type II Type III

Supracondylar FractureGartland Classification

Supracondylar FractureManagement

Classification Implications Management

Type I Undisplaced, periosteum intact with significant inherent stability of the fracture

Simple immobilization with a cast applied at 90o elbow flexion

Type II Displaced, with an intact posterior cortex

M&R (‘K’ wires) followed by(i) Immobilization with a

cast applied at 90o elbow flexion

(ii) Insertion of 2 lateral pins

Type III Periosteum completely torn, no cortical contact

M&R followed by insertion of 2 crossed pins

Supracondylar FractureManagement

Cast Immobilization at 90o Flexion

Insertion of 2 Lateral Pins

Insertion of Crossed Pins

Supracondylar FractureComplications

• Cubitus Varus Deformity

• Brachial Artery Injury• Neurological Deficit• Compartment Syndrome

Supracondylar FractureComplications

• 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.

• Types I-V

Salter-Harris Classification

Salter-Harris Classification

• Guides management

Type Management

I & II Conservative

III & IV Operative

V 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