Developmental dysplasia of the hip Legg-Calve-Perthes disease Lower extremity length inequality Neuromuscular disorder
Cerebral palsy Muscular dystrophy (Duchenne) Adolescent: 11 years of age to maturity
Septic arthritis, osteomyelitis, myositis Trauma Rheumatologic disorder Slipped capital femoral epiphysis: acute; unstable Malignancy
Slipped capital femoral epiphysis: chronic; stable Developmental dysplasia of the hip: acetabular dysplasia Lower extremity length inequality Neuromuscular disorder
Fractures account for 10% to 15% of all childhood injuries.The anatomic, biomechanical, and physiologic differencesin children account for unique fracture patterns and management. Fracture terminology helps describe fractures(Table 198-1).
The pediatric skeleton has a higher proportion of cartilage and a thicker, stronger, and more active periosteum, capable of producing a larger callus more rapidly than in an adult. The thick periosteum may decrease the rate of displaced fractures and stabilize fractures after reduction. Because of the higher proportion of cartilage, the skeletally immature patient can withstand more force before deformation or fracture than adult bone. As children mature into adolescence, the rate of healing slows and approaches that of adults.
Buckle or torus fractures occur after compression of the bone; the bony cortex does not truly break. These fractures will typically occur in the metaphysis and are stable fractures that heal in approximately 4 weeks with immobilization. A common example is a fall onto an outstretched arm causing a buckle fracture in the distal radius.
Complete fractures occur when both sides of bony cortex are fractured. This is the most common fracture and may be classified as comminuted, oblique, transverse, or spiral, depending on the direction of the fracture line.
Greenstick fractures occur when a bone is angulated beyond the limits of plastic deformation. The bone fails on the tension side and sustains a bend deformity on the compression side. The force is insufficient to cause a complete fracture (Fig. 198-1).
The bone fragments separate completely Incomplete
The bone fragments are still partially joined Linear
Referring to a fracture line that is parallel to the bone’s long axis Transverse Referring to a fracture line that is at a right angle to the bone’s long axis Oblique Referring to a fracture line that is diagonal to the bone’s long axis Spiral Referring to a twisting fracture Comminution A fracture that results in several fragments Compaction The bone fragments are driven into each other Angulation The fragments have angular malalignment Rotation The fragments have rotational malalignment Shortening The fractured ends of the bones overlap Open A fracture in which the bone has pierced the skin
Bowing fractures demonstrate no fracture line evident on radiographs, but the bone is bent beyond its limit of plastic deformation. This is not a true fracture, but will heal with periosteal reaction.
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Fractures involving the growth plate constitute about 20% of all fractures in the skeletally immature patient. These fractures are more common in males (2:1 male-female ratio). The peak incidence is 13 to 14 years in boys and 11 to 12 years in girls. The distal radius, distal tibia, and distal fibula are the most common locations.
Ligaments frequently insert onto epiphyses. Thus, traumatic forces to an extremity may be transmitted to the physis, which is not as biomechanically strong as the metaphysis; it may fracture with mechanisms of injury that may cause sprains in the adult. The growth plate is most susceptible to torsional and angular forces.