Fractures In Children

Fractures in children demand a special consideration because the skeleton of children though resembles adult skeleton is kind of different. Anatomically as well as physiologically, bones in  children are quite different from adult bones.

Roughly about one third of children have had a fracture by the age of 18.  Fractures of the forearm are most common injuries of the children.

Children are quite active physically and often adventurous,making them more vulnerable to trauma.

Crying Face

How Does Child Bones Differ From Adult?

Bones in children have a great healing power and fractures in children almost always unite . It is rare to find a fracture not uniting in case of fractures in children and whenever it occurs, there would be a strong reason for it like infection or some other pathology.

Bones of children are softer and pliant as compared to adult bones. To compare imagine a twig and a hard stick. Because of this bones in children can absorb a greater trauma without getting fractured.

Periosteum, the layer that covers the bones, in children is quite thick in comparison to adult periosteum. It is difficult to tear easily because of thickness and thus prevents displacement of fractured pieces.

Rate of healing of fractures in children is faster than that in adults. This rate decreases with age of the child.

epiphysealfracture-copy.jpgOne another big difference in bones of children are is growth of the bone. This growth occurs at the bone ends which harbor a growth plate called physis. Physis is separated from joint by a bony tissue called epiphysis. Injury to this physis or growth plate is a peculiar phenomenon in children because the growth plate ceases to function and fuses with the bone after completion of growth.

Types of Fractures in Children

Apart from the usual types, there are few fractures that occur in children only. These fractures are

greensick.jpgGreenstick fractures

As bones of children more pliable than adult bone, a fracture pattern may occur in which fracture is not complete. Such fracture are called Greenstick fractures. In this one side of the bone breaks and one side is bent.

The name for a greenstick fracture comes from the analogy of breaking a young, fresh tree branch. when you try breaking a fresh tree branch it snaps on the outer side of the bend while the inner side is bent, and still in continuity.

Though incomplete, the greenstick fracture must be bent back into the proper position and then plaster should be applied for appropriate time so as to maintain the position till the fracture unites.

Torus Fractures

Torus fractures in children are the fractures where one cortex of the bone bends (buckles) upon itself without breaking the other side.

Epiphyseal Fractures

Injuries to the growth plate  are  restricted only to child skeleton. These injuries are called epiphyseal injuries and can result in stoppage of growth and bone shortening.

Causes of Fractures in Children

Accidental trauma can occur in a variety of settings and can be considered to occur in the following five environments-

1. Home

2. School

3. Play and recreational activities

4. Motor vehicle and road accidents

5. Uncommon causes are ice cream truck, water tubing, gunshot wounds etc.

Symptoms

Very young children after injury will cry and would restrict the use of injured area. Following are the most common symptoms of a fracture.

  • Pain in the injured area
  • Swelling in the injured area
  • Warmth, bruising, or redness in the injured area
  • Deformity
  • Difficulty using or moving the injured area in

Imaging

As with adults, xray is first investigation and would suffice in most of the cases.

In a fracture with preexisting pathology, other investigations like CT or MRI may be required.

Treatment

Most of the fractures in children are treated by non operative means which includes splints, plaster casts and traction.

Surgery is being done for many a fractures now to limit the time on bed and increase early mobility.

Pathological Fractures in Children

A pathological fracture is defined as a fracture that occurs through abnormal bone, a  bone that lacks normal biomechanical and viscoelastic properties.

Pathological fractures may result from generalized bone weakness caused by an external process like radiation. Another example of external cause is hole caused by a procedure like fixation or biopsy.

Most of the fractures, however, have internal causes which could be localized or generalized.

Fracture of upper end of femur in an eight years old child. If you notice carfefully, you can see a lytic lesion at the site of the fracture.

pathological fracture of upper end of femur in a child

Pathological Fracture of Upper End Femur in A Child

 

Generalized bone Diseases Causing Pathological Fractures In Children

  • Rickets
  • Osteogenesis imperfecta
  • Osteopetrosis
  • Antley-Bixler syndrome
  • Cytochrome P450 oxidoreductase deficiency
  • Jaffe-Campanacci syndrome
  • Bruck syndrome
  • Malabsorption syndrome
  • Cushing’s syndrome
  • Scurvy
  • Carbonic anhydrase type 2 deficiency
  • Metastases
  • Hypophosphatasia
  • Polyostotic osteolytic expansile dysplasia
  • Copper deficiency
  • Osteoporosis-pseudoglioma syndrome
  • Pyknodysostosis
  • Hyperparathyroidism
  • Osteoporosis
  • Anorexia nervosa
  • Gorham’s vanishing bone disease

Localized Conditions Causing Pathological Fractures In Children

  • Enchondroma
  • Infection-Osteomyelitis
  • Bone Tumors – Benign and malignant
  • Tumor like lesions of bone
  • Bone Cyst
  • Retrauma in recently united bone

Pathological fractures are special as apart from the fracture, pathology also needs to be managed.

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Comments

  1. frances cherry says

    I am trying to find the protocal for how many xrays a 13 year old child should have after breaking his radius and ulnar bones.We seem to be having weekly xrays,

  2. Dr Arun Pal Singh says

    @frances cherry,

    The bone should unite in 4-6 weeks.

    Weekly xrays may be done where redisplacement of the fracture is a concern.

    How much time has passed since injury.

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