PAEDIATRIC TRAUMA

Christian Yonathan
What differences exist between child’s
bone and an adult?
Fractures in children
• Periostium: thick
• More rapid fracture healing
• Ligaments: stronger than bone, fracture more common
• Blood supply: rich metaphyseal circulation ending at physis
• Special problem for diagnosis
• Less tolerance of major blood loss
Less dense more porous
more Haversian canals
more vascular channels Tolerate more degree of
deformation
incomplete fracture
Periost is thicker and stronger more vascular

Biologically active periosteum

• more callus formation
• healing soon
• periosteal remodeling
Healing process
remodel during and after fracture can correct angulation
no delayed or nonunion
Growth plate
Physeal remodeling
Epiphysiolysis
Fracture classification

Incomplete :
Bowing (bend)
Buckle (torus)
Greenstick

Complete
Evaluation of child with fracture
• No or limited history
• Child cannot localize injury: evaluate limb
• Explain everything to child
• NV evaluation, document before and after reduction
• Periodic evaluation for compartment syndrome---crying child
X-rays and interpretation
• AP/Lat, joint above and joint below
• X-ray other side for comparison
• Be familiar with normal appearance of bones and epiphyses, epiphy
seal lines
• X-ray entire limb if unable to locate inj.
• Soft tissue sign: posterior fat pad sign
• CT for intra-articular #
Treatment
 Mostly conservative
 Reduction, immobilisation
 Alignment : not grossly angulated
no rotation
 Rotational deformity : inexcusable : nev
er remodel
 Slight angulation : acceptable
 Slight shortening (femur fr.) : acceptable
Surgical indication
1. Intraarticular displaced fracture
2. Interposition
3. SH. III, IV
4. Open fracture
5. A.N. complication
6. Conservative : fail
 Complications
• Neuro
• Vascular
• Compartmental syndrome
• Myositis ossificans
Suspect child abuse in
• Long bone # in non-ambulating child
• When history does not fit in
• An un-witnessed injury
• Multiple # in various stages of healing
• Skin bruises
• Corner # , metaphysio-epiphysial jtn
• DD: OI, vit D, congenital absence of pain
salter harris classification
 Children’s fractures

• Around elbow
• Radius and ulna
Pulled elbow
• Head of radius smaller than annular ligament up to 5 yrs
• Radial head subluxed beneath annular ligt when child lifted up on a
straight elbow
• Pain, doesn’t move the forearm
• History +-
• Hold elbow , fully supinate flexed elbow, click felt. Give your keys to
child. Moves fore-arm for the first time . No xray
Fracture radius ulna
Supracondylar fractur
e
of humerus
Supracondylar fracture
• Absent pulse?
• K-wires to main reduction. Cross pins
• 17% risk of ulnar nerve injury
Lateral Condyle
of humerus
 Children’s fractures
• Lower limbs
• Higher velocity
• Watch out for physeal arrest