02 Sep Child Fractures
Except for the first year of life, the most important causes of child (1-14 years old) deaths are accidents. Skeletal system traumas and movements that are not suitable for children's bone health constitute -15 of childhood traumas. Anatomical and physiological differences of children's bones Child Fractures It requires examination under a separate heading. As Nişantaşı Orthopedics, we explain these topics one by one for you.
What are Child Fractures?
Children's bones contain epiphyseal and physeal cartilages, which enable longitudinal growth and ossify at different ages. The articular surfaces form the tip of the epiphyses. Apophyseal points are bone protrusions at the ends of long bones to which tendons attach. Asymmetric growth of the epiphyseal plate or failure to grow at all due to damage to the epiphyseal cartilage that may occur in cases where the fracture line passes through the epiphyseal line, or as a result of failure to achieve anatomical reduction in the epiphysis, causes shortness and angular deformities in the late period. Therefore, pediatric fractures involving the epiphyseal region should be followed carefully. Epiphyseal fractures are more common in boys than girls. The reason for this is that the growth cartilage in men remains open for many years.
Epiphyseal fractures are classified as follows by authors Salter and Harris:
Type 1: There is separation from the physis line without a fracture in the epiphysis or metaphysis.
Type 2: It concerns the fracture physeal line and metaphysis. The epiphysis is separated from the metaphysis along with a piece. It is the most common type.
Type 3: It concerns the fractured epiphysis and physis line. A part of the epiphysis is separated from the physis line. It is an intra-articular fracture and the metaphysis is intact.
Type 4: It concerns the fractured metaphysis, physis and epiphysis. A piece of the epiphysis is separated from the physis line along with a piece of the metaphysis. It is an intra-articular fracture.
Type 5: The physis line is crushed (compression). There is compression and narrowing in the physis line. It is rare and can be seen in falls from a height. Growth cartilage damage is definitive and results in shortening and angulation.
The periosteum surrounding children's bones is thicker and richer in blood vessels than in adults, and has faster bone formation properties. This feature Child Fractures It ensures that it boils in a shorter time and that the problem of non-boiling (nonunion) is almost non-existent. For this reason
Early reduction and fixation of fractures is necessary to prevent malunion after childhood fractures.
The healing time of fractures is inversely proportional to age. While a femoral shaft fracture heals within a few weeks in a newborn baby, this period is measured in months in adults. Additionally, the fractured area of the bone also affects the healing rate. In long bones, metaphyseal fractures heal in a shorter time than shaft fractures. Thickness of the periosteum can also prevent bone fragmentation due to trauma. That's why multipart fractures are less common in children.
Haversian canals in cortical bones in children are wider than in adults. This feature allows bones to be elastic. During childhood, the fluid ratio per unit volume of a bone is high and its mineral content is low. Therefore, in the pediatric period, the elastic modulus of the bone is lower (less fragility) and the end point of resistance to stress loading is higher. For these reasons, the forces that cause displaced fractures in adults cause bending and greenstick fractures in children. Another type of incomplete fracture seen in children is torus fractures. These fractures occur as a result of impaction of the metaphyseal bone under compression.
child fractures After remodeling capacity is very high. The openings are corrected. In an angulated fracture, transverse growth increases with the compression of the cortical bone on the concave side. With the tension on the convex side, the excess here is resorbed. The deformity corrects and the bone regains its anatomical shape (Wolf
law). Remodeling is the restoration of a normal bone's deformity due to malunion over time. Remodeling potential is greater at younger ages, when the fracture line is close to the physis, and in fractures in the direction of joint movement. The chance of recovery of varus/valgus angulations is low. Rotational angulations do not correct.
Growth and remodeling can help correct residual displacements in some cases, but in cases such as epiphyseal fractures, they are potential enemies that increase deformity over time. Bone length increases in pediatric fractures. Due to hyperemia during the healing process, the epiphysis is affected and longitudinally
growth accelerates. The closer the fracture line is to the epiphyseal growth plate, the greater the longitudinal growth.
Radiographic Evaluation in Child Fractures:
Diagnosis may not be made on radiographs because children's bones are largely composed of cartilage, especially in the joint areas, that is, ossification is not completed. In this case, the importance of physical examination becomes evident. Negative plain radiographs in a patient with confirmed signs and symptoms of fracture should not mislead the physician. Therefore, if the right films are not requested for children, fractures may be missed. The examination should be performed with comparative radiographs of the bilateral and intact symmetrical side. Additionally, the joints at both ends of the bone under investigation should be included in the radiograph. Rarely, ultrasonography and magnetic resonance imaging can be used for atypical fractures.
Signs and Symptoms:
There is always pain and sensitivity in fractures, especially those that increase with movement. Swelling is a sign of a fracture hematoma. Deformity occurs as a result of the fracture ends overlapping, angling or rotation. No deformity is seen in unseparated fractures. Abnormal movement movement in the middle of a long bone
is that it is. Sometimes there may be limitation of movement due to pain and spasm. Crepitus may be especially noticeable when the patient is being transported. Loss of function may be due to pain and loss of the lever arm. Neurovascular injury is most commonly seen in humerus and femur fractures.
Treatment of Child Fractures:
Generally, Cchild fractures Conservative treatment methods are sufficient. Nonunion is very rare and indications for surgical treatment are limited. In pediatric fractures, the treatment approach generally applied to adults is used. These principles;
- First aid,
- Reduction (1. Rotational and angular harmony, 2. Length restoration, 3. Contact of fracture ends),
- It can be summarized as protection and restoration of function.
In some cases, open reduction and internal fixation may be necessary for pediatric fractures.
These are in the elbow area of the upper extremity;
- Displaced lateral condyle fractures of the humerus
- Displaced lateral epicondyle fractures of the humerus
- Displaced medial epicondyle fractures of the humerus
- Radius neck fractures (if there is 30° angulation)
- Unstable Monteggia fracture-dislocations
- Olecranon fractures
In the lower extremity, knee area;
- patella fractures
- Tuberositas tibia fractures
- Eminentia tibialis fracture
- Unstable fractures-dislocations of vertebrae
- Femoral neck fractures
- Femur trochanteric region fractures
- Salter Type II, III and IV epiphyseal fractures (if displaced and closed cannot be reduced)
- Fractures that cause acute circulatory impairment
- Intra-articular fractures (if displaced)
- Fractures that cannot be reduced by closed reduction are fractures.