Children's fractures and epiphysiolysis

There are some types of fractures in children that we do not see in adults. In general, we divide children's fractures into:


 * epiphyseal separation and epiphyseal fracture
 * bending fractures - they are treacherous, the fracture line is not visible, the bones are only bent - so-called bowing fractures
 * willow stick type fractures – bone fracture without breaking the periosteum – so-called greenstick fractures
 * compression, "torus" fractures



Separation of the epiphyses

 * the growth cartilages are the weakest part of the child's skeleton (the ligaments are several times stronger, therefore there will be no dislocation, but the epiphysis breaks)
 * separation occurs mainly in the hypertrophic zone of growth cartilage, in the layer of degeneration and provisional calcification

Classification according to Salter and Harris

 * 1st type – pure separation of the epiphysis in the growth joint


 * there is no bony lesion, if it is not dislocated it can be overlooked
 * if the germinal layer is not affected, the prognosis is good


 * 2nd type – separation of the physis, but in a certain place there is a fracture towards the metaphysis


 * on x-ray we see a triangular fragment (Thurston-Holland sign)
 * there is also no growth disorder
 * type 1 and 2 are epiphysiolysis


 * 3rd type – right epiphyseal fractures


 * the fracture line starts at the joint, runs through the core of the epiphysis to the periphery
 * the likelihood of a bone growth disorder is significant


 * 4th type – transepimetaphyseal fractures


 * the epiphyseal vascular system is also often broken - growth disorders


 * 5th type – growth joint injuries caused by axial compression


 * with a fresh injury, the diagnosis is quite problematic



Therapy

 * children often tolerate limb injuries surprisingly well and a negative x- ray often means nothing!
 * sometimes it is good to add an x-ray of a healthy limb (special – carpal bones, patella, etc.)
 * conservative treatment dominates
 * in general – we conservatively solve types 1, 2 and 5 (types 3 and 4, if there is no dislocation)

Children's fractures in special circumstances

 * birth fractures – most often the clavicle, then diaphyseal fractures of the humerus and femur
 * fractures in the abused child syndrome – the child is screaming, scared, hematomas on the skin, suffusion, multiple epiphyseal separations
 * pathological fractures - in benign bone affections - mainly juvenile bone cysts, non-ossifying fibroma , chondroma , etc.

Consequences of childhood fractures

 * most heal without sequelae
 * growth plate disorders may occur
 * the most common cause of bone growth arrest – the formation of so-called bone bridges


 * healing bridge – formed in the gap of an imperfectly repaired physis during distraction
 * osteonecrotic bridge – by breaking the cells of the reserve and proliferative zone as a result of a disorder of the epiphyseal arteries
 * according to the location in the bone, bridges are:
 * peripheral – axial deviation of the limb
 * central – shortening of the limb, with further growth the growth joint is deformed into a conical shape ("tenting")
 * combined – the most severe – both shortening and angulation

Related Articles

 * Coxa vara adolescentium

Source

 * BENEŠ, Jiří. Study materials  [online]. [feeling. 2009]. < http://jirben.wz.c z >.