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Pediatric Pediatric Orthopedic Orthopedic FracturesFractures
Dafina Good, MDDafina Good, MDPediatric Emergency Medicine Pediatric Emergency Medicine
FellowFellowEmory University School of Emory University School of
MedicineMedicineChildren’s Healthcare of AtlantaChildren’s Healthcare of Atlanta
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ObjectivesObjectives Review unique structural and physiologic Review unique structural and physiologic
differences between children and adult differences between children and adult skeletal systemsskeletal systems
Review fracture patterns unique to Review fracture patterns unique to childrenchildren
Review the Salter-Harris classification of Review the Salter-Harris classification of pediatric physeal fracturespediatric physeal fractures
Review common presentations and Review common presentations and EPONYMS of common pediatric and adult EPONYMS of common pediatric and adult fracturesfractures
Review Ottawa ankle and knee criteriaReview Ottawa ankle and knee criteria
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EpidemiologyEpidemiology
Orthopedic trauma accounts for 10-Orthopedic trauma accounts for 10-15% of ED visits in urban pediatric 15% of ED visits in urban pediatric hospitalshospitals
It is estimated that over 40% of boys It is estimated that over 40% of boys and over 25% of girls will sustain a and over 25% of girls will sustain a fracture during childhood fracture during childhood
Rapid growth of organized sportsRapid growth of organized sports
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Skeletal Differences Skeletal Differences between Children and between Children and
AdultsAdults Presence of Growth Plates (Physis)Presence of Growth Plates (Physis)
Growth plate injuries constitute up to 25% of all skeletal Growth plate injuries constitute up to 25% of all skeletal injuries in childreninjuries in children
Presence of Secondary Ossification Centers Presence of Secondary Ossification Centers (Epiphysis)(Epiphysis)
Rapid healing Rapid healing More metabolically active periosteum in childrenMore metabolically active periosteum in children
Greater Potential to RemodelGreater Potential to Remodel More porous and more pliable bonesMore porous and more pliable bones Fracture patterns unique to childrenFracture patterns unique to children Fractures are more common than sprains in young Fractures are more common than sprains in young
childrenchildren Ligaments and tendons attaching one bone to another have Ligaments and tendons attaching one bone to another have
greater strength than immature bonesgreater strength than immature bones
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Normal Bone AnatomyNormal Bone Anatomy
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Normal Bone AnatomyNormal Bone Anatomy
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Describing FracturesDescribing Fractures Open vs. ClosedOpen vs. Closed Location (shaft, through growth plate etc.)Location (shaft, through growth plate etc.) Displacement in mmDisplacement in mm Shortening in mmShortening in mm Impaction if presentImpaction if present Angulation, degree and direction Angulation, degree and direction
(midshaft-direction of terminal fragment)(midshaft-direction of terminal fragment) Salter Harris ClassificationSalter Harris Classification Neurovascular statusNeurovascular status
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Describing FracturesDescribing Fractures
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Describing FracturesDescribing Fractures
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Salter Harris Salter Harris ClassificationClassification
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Fractures Unique to Fractures Unique to ChildrenChildren
Buckle or Torus Fractures
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Fractures Unique to Fractures Unique to ChildrenChildren
Greenstick Fractures
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Fractures Unique to Fractures Unique to ChildrenChildren
Greenstick Fractures
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Fractures Unique to Fractures Unique to ChildrenChildren
Bowing Fractures
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Fractures unique to Fractures unique to childrenchildren
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Fractures unique to Fractures unique to childrenchildren
Toddler’s Fracture
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Common Fracture Common Fracture EponymsEponyms
Who Named It?Who Named It?From the neck down to the toes!From the neck down to the toes!
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Jefferson FractureJefferson Fracture
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Hangman’s FractureHangman’s Fracture
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Teardrop FractureTeardrop Fracture
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Chance FractureChance Fracture
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Boxer’s FractureBoxer’s Fracture
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Hand AnatomyHand Anatomy
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Bennett’s FractureBennett’s Fracture
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Colle’s FractureColle’s Fracture
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Smith’s FractureSmith’s Fracture
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Nightstick FractureNightstick Fracture
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Monteggia FractureMonteggia Fracture
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Monteggia FractureMonteggia Fracture
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Galeazzi FractureGaleazzi Fracture
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Supracondylar FractureSupracondylar Fracture
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Ossification Centers – C-R-I-T-Ossification Centers – C-R-I-T-O-EO-EApproximate age of appearanceApproximate age of appearance
CCapitellum - 1 yearapitellum - 1 yearRRadial head - 3 yearsadial head - 3 yearsIInternal epicondylenternal epicondyle (Medial epicondyle)-5 years (Medial epicondyle)-5 yearsTTrochlea - 7 yearsrochlea - 7 yearsOOlecranon - 9 yearslecranon - 9 yearsEExternal epicondyle xternal epicondyle (Lateral epicondyle)-11 years (Lateral epicondyle)-11 years
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Proximal Humeral Proximal Humeral FractureFracture
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Slipped Capital Femoral Slipped Capital Femoral EpiphysisEpiphysis
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SCFE’s Klein’s LineSCFE’s Klein’s Line
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Klein’s LineKlein’s Line
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Pelvic Avulsion FracturesPelvic Avulsion Fractures
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Common Locations of Common Locations of Pelvic Avulsion FracturesPelvic Avulsion Fractures
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Spiral Femur FractureSpiral Femur Fracture
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Osgood Slater Disease vs Sinding Osgood Slater Disease vs Sinding Larsen-JohanssonLarsen-Johansson
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Patellar FracturePatellar Fracture
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Knee AnatomyKnee Anatomy
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Knee AnatomyKnee Anatomy
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Ottawa Knee RulesOttawa Knee Rules
Characteristics of Patients Who Should Characteristics of Patients Who Should Undergo Radiography After Knee Trauma Undergo Radiography After Knee Trauma
Ottawa knee rulesOttawa knee rulesAge 55 years or olderAge 55 years or olderTenderness at head of fibulaTenderness at head of fibulaIsolated tenderness of patellaIsolated tenderness of patellaInability to flex knee to 90 degreesInability to flex knee to 90 degreesInability to walk four weight-bearing steps immediately Inability to walk four weight-bearing steps immediately after the injury and in the emergency departmentafter the injury and in the emergency department
Pittsburgh decision rulesPittsburgh decision rulesBlunt trauma or a fall as mechanism of injury plus either of Blunt trauma or a fall as mechanism of injury plus either of the following:the following:Age younger than 12 years or older than 50 yearsAge younger than 12 years or older than 50 yearsInability to walk four weight-bearing steps in the Inability to walk four weight-bearing steps in the emergency department emergency department
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Corner FractureCorner Fracture
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Bucket Handle FracturesBucket Handle Fractures
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Maisonneuve FractureMaisonneuve Fracture
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Tillaux FractureTillaux Fracture
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Tillaux FractureTillaux Fracture
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CT Scan of Tillaux CT Scan of Tillaux FractureFracture
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Triplane FractureTriplane Fracture
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Triplane FractureTriplane Fracture
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What’s the Difference?What’s the Difference?
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Anatomy of the Fifth Anatomy of the Fifth MetatarsalMetatarsal
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Reasons to Refer to Reasons to Refer to OrthopedicsOrthopedics
Open FracturesOpen Fractures Unacceptably displaced fracturesUnacceptably displaced fractures Fractures with associated neurovascular Fractures with associated neurovascular
compromisecompromise Significant growth plate or joint injuriesSignificant growth plate or joint injuries Pelvic/Femur fractures (other than minor Pelvic/Femur fractures (other than minor
avulstions)avulstions) Spinal FracturesSpinal Fractures Dislocations of major joints other than Dislocations of major joints other than
shoulder/kneeshoulder/knee Clavicle (distal third)Clavicle (distal third) Fractures prone to Nonunion/MalunionFractures prone to Nonunion/Malunion
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Why do we do it?Why do we do it?
Prevent Growth arrestPrevent Growth arrest Prevent malunion or nonunionPrevent malunion or nonunion Restore function as close to Restore function as close to
physiologicphysiologic