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

Willow twig type fracture - X-ray

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

Classification according to Salter-Harris

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:

1. peripheral – axial deviation of the limb
2. central – shortening of the limb, with further growth the growth joint is deformed into a conical shape ("tenting")
3. combined – the most severe – both shortening and angulation

Links

Related Articles

• Coxa vara adolescentium

Source

• BENEŠ, Jiří. Study materials  [online]. [feeling. 2009]. < http://jirben.wz.cz >.

References

• Dungl, P, et al. Orthopedics. 1st edition. Prague: Grada Publishing, 2005. 1273 pp.  ISBN 80-247-0550-8 .

Category:Surgery Category:Pediatrics Category:Traumalogy