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- 20% of pediatric patients with acute traumatic injuries will have a fracture
- Boys have fractures more commonly than girls
- Diaphysis: Physis to physis; bone shaft
- Epiphysis: Cartilaginous center at or near end of bone that is site of bone growth
- Epiphyseal (growth) plate: Radiolucent line between epiphysis and metaphysis; cartilaginous
- Metaphysis: Region of rapidly growing trabecular bone underlying base of cartilaginous growth plate; between diaphysis and epiphysis
- Most long bones are ossified by the end of puberty
- Bones are highly resilient, elastic, and springy
- Allow for fractures not seen in adults:
- Greenstick fracture:
- Incomplete fracture through cortex on opposite side of impact
- Torus (buckle) fracture:
- Usually at junction of metaphysis and diaphysis
- Compression of bone of 1 cortex
- Plastic deformity:
- Bowing without disruption of cortex
- Fractures involving the physis
- Cartilaginous growth plates are potential areas of injury.
- Ligaments more resistant to injury than growth plates
- Salter–Harris classification:
- Risk of growth disturbance increases from type I to type V.
- Type I:
- Separation of epiphysis from metaphysis without displacement or injury to the growth plate
- Tenderness and pain at point of growth plate
- Radiograph typically normal
- Growth disturbance is rare.
- Type II:
- Metaphyseal fracture extending to physis
- Most common
- Growth disturbance is rare.
- Type III:
- Intra-articular fracture extending through the epiphysis into the physis
- Most common site is distal tibial epiphysis.
- Growth disturbance possible
- Type IV:
- Epiphyseal, physeal, and metaphyseal fracture
- Lateral condyle of humerus is the most common site.
- Growth disturbance highly likely
- Type V:
- Crush injury to epiphyseal plate, producing growth arrest
- Usually occurs in joints that move in only 1 plane such as knee
- Fractures often accompany dislocations.
- Nonaccidental trauma (NAT) if history inconsistent with findings
- Mechanism is useful in defining the potential and type of injury
- Obesity and rapid growth spurts are risk factors.
- Any fracture in a child younger than 1 yr of age in whom history is not consistent with injury
- Metaphyseal “corner” fractures are pathognomonic.
- Posterior rib fractures
- Spiral femur fracture
- Fractures at different stages of healing
- Skull fractures crossing suture lines, especially in children younger than 1 yr
- Unusual behavior in child or parent
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