types of fractures in children and its treatment

Fractures in children are always different from fractures in adult for the following reasons :

1. complete fractures are rare due to thick periosteal sleeve and greater elasticity
2. for the same reasons mentioned above, buckle (torus fractures) and greenstick fractures are more common
3. fracture displacement are relatively less common
4. fracture bleeding is also less
5. avulsion fractures are more common because bone give away much earlier than the ligaments
6. disruption of the epiphyseal plate are relatively more common because they form the weakest portion of the bone in the children and account for nearly one-third of all childhood fractures
7. a pediatric unites faster
8. differential periosteal activity causes better remodeling which is more likely in
   • the younger child
   • the nearer the fracture to the epiphyseal plate
   • address any deformity angulated in the plane of joint movement,
9. all tissues in children not only heal well but rapidly too
10. joint stiffness a bugbear in adults, rarely happens in children

Types of fractures

1. Greenstick fractures
   • in this children exclusively exhibit a type of incomplete fracture where one cortex breaks while the other remains intact
2. Buckle fracture (torus fracture)
   • a compressive force commonly causes this fracture in the metaphyseal region, resulting in cortex bucking, often observed at the distal radius. treatment involves a plaster cast or a futura type of wrist splint
3. Plastic bowing
   • here bone deforms but does not break. seen in paired bones and there is a microfracture on the concave side

Patterns of fractures

1. it is simple or compound. the latter variety is rare
2. the fracture in either case could be transverse, oblique, spiral, comminuted, or segmental.

Treatment

1. Problems in treatment of child fracture
   • the younger child is fretful and difficult to examine fully
   • worried parents and a crying child pose problems
   • many fracture are difficult to see and need x-ray of good quality
   • general anesthesia required for manipulation
   • circulatory compromise is relatively common
   • redisplacement after reduction is common during the first week
   • wound care should be the same
   • allowing a 1 cm overlap is a common practice to address the prevalent issue of overgrowth following a long bone fracture
2. Conservative methods
   • these can be helpful in undisplaced fractures
     • NSAIDs
     • crepe bandage
     • slings
   • step by step conservative treatment (closed reduction and casting) greenstick bends methods for forearm bone fracture
   • Closed reduction : if the bones are bent and of one cortex is broken, then closed reduction under general anesthesia and breaking of the other cortex is done. this is followed by plaster cast application. if the other cortex is not broken, then there are chances of malunion due to differential growth of one cortex
   • Closed reduction and manipulation : this is preferred if the fracture is displaced and is done under general anesthesia in major OT. retention is usually by slap, cast and rarely by traction
   • Closed reduction by traction : this can also be attempted in certain situation, e.g. Gallow’s traction, Dunlop’s traction, or overhead olecranon skeletal traction in difficult supracondylar fractures of humerus
3. Surgery
   • Open reduction and internal fixation: this is rarely done in children. indications being failed closed reduction, redisplacement, multiple injuries, neurovascular injuries, delayed union and soft tissue interposition
   • Closed reduction and percutaneous fixation of late, this method of treatment is gaining popularity due to simplicity of technique and reduced complications rate associated with the open techniques.
     • the most popular example of this technique is closed reduction and percutaneous k-wire fixation of closed displaced supracondylar fracture of humerus in children
   • Corrective osteotomy : This is required in cubitus varus deformity due to malunited supracondylar fracture