Type of Fracture
- usually greenstick or buckle because periosteum is thicker and stronger
- adults fracture through both cortices
Epiphyseal Growth Plate
- plate often mistaken for fracture and vice versa
- x-ray opposite limb for comparison
- mechanism which causes ligamentous injury in adults causes growth plate injury in children
- intra-articular fractures have worse consequences in children because they usually involve the growth plate
Anatomic Reduction
- gold standard with adults
- may cause limb length discrepancy in children (overgrowth)
- accept greater angular deformity in children (remodeling)
Time to Heal
- shorter in children
Always be Aware of the Possibility of Child Abuse
- make sure mechanism compatible with injury
- index of suspicion, look for other signs, including x-ray evidence of healing of fractures at other sites
 |
PEARL
greenstick fractures are easy to reduce but can redisplace while in cast due to intact periosteum |
Epiphyseal Injury
|
SALT(E)R–Harris Type |
Description |
Treatment |
|---|---|---|
|
I (Stable) |
transverse through growth plate |
closed reduction and cast immobilization heals well, 95% do not affect growth |
|
II (Above) |
through metaphysis and along growth plate |
|
|
III (Low) |
through epiphysis to plate and along growth plate |
anatomic reduction by ORIF to prevent growth arrest |
|
IV (Through) |
through epiphysis and metaphysis |
|
|
V (Ram) |
crush injury of growth plate |
high incidence of growth arrest; no specific treatment |
Stress Fractures
Mechanism
- common in adolescent athletes
- most common in lower extremity (metatarsals > calcaneus > tibia)
- two categories:
1.) insufficiency fracture: stress applied to a weak or structurally deficient bone
2.) fatigue fracture: repetitive, excessive force applied to normal bone
Diagnosis and Treatment
- localized pain and tenderness over the involved bone
- plain films may not show fracture for 2 weeks
- bone scan positive in 12-15 days
- treatment is rest from strenuous activities to allow remodeling (can take several months)
