Fractures of the child

Fractures de l'enfant

1- Diaphyseal fracture:

The 3 elements of difference with the adult

* The periosteum of the child is thick and resistant

* Elasticity and plasticity important

* The treatment is in most cases orthopedic

Two specific types of child:

– Plastic deformation: mainly at the ulna (ulna) and fibula (fibula). It is irreversible but can be adjusted with growth.

– Fractures in green wood: a single cortical fractured there is periosteal break next. Those on the opposite side stand.

It is often necessary to break the opposite side not fractured during reduction to avoid secondary displacement.

2- Metaphyseal fracture:

Fractures in lumps of butter

– Are specific child

– Are frequent due to the lower strength metaphyseal bone

– Occur by impaction of the diaphyseal bone in metaphyseal bone less resistant

– Occur mainly in the metaphyses of long bones

– To translate clinically by pain without distortion

– Consolidation is easy and fast

– Remodeling of these fractures is greater than in the diaphyseal fractures

3- Epiphyseal fracture:

* These are specific fracture because as relevant to the cartilage growth and thereby sound can later on growth

* It takes time monitor the evolution of these injuries

* Ability to post-traumatic epiphysiodesis (fusion of the growth plates) => cessation of growth

Classification Salter-Harris:

– Type I: pure epiphyseal separation -> orthopedic treatment. Newborn and young children; excellent prognosis

– Type II: epiphyseal separation with respect metaphyseal (the most common type); Children 10 years and older; good prognosis; almost always orthopedic treatment

– Type III: epiphyseal separation with epiphyseal line. intra-articular fracture; very rare ; anatomic reduction necessary, sometimes surgical.

– Type IV: transmétaphyso-epiphyseal fracture. almost always surgical reduction. typically poorer prognosis

– Type V: crushing of the growth plate. difficult diagnosis, often before a retrospective growth of inequality of a member and / or progressive angulation

4- Consolidation:

– It is much faster than adults and more rapid that the child is younger

– It is favored by the respect of the periosteum and périfracturaire hematoma.

– Vicarious Elongation -> inequality hyperactivity length of the growth plate adjacent to the fracture. One inequality> 2 cm lower limbs requires therapeutic measures.

– Bone remodeling can correct malunion but certain conditions are necessary:

* Lack of rotation

* Malunion near the most active growth of cartilage (near the knee, elbows away)

* Growth potential still large (children <10 years)

* Cal not vicious and excessive deformation in the plane of motion of the joint

5- Fractured humerus:

– Fractures of the distal humerus are in 2nd place after fractures of the lower extremity bones of the forearm.

– Treatment is often surgical

– The legacy-type axial deviation or stiffness are rare.

Supracondylar fracture:

– The supracondylar fractures are the most common (40-60%) of elbow fractures in children.

– The mechanism -> fall on the hand, elbow extended.

– The supine varus deviation is the most common secondary complication of extension fractures.

– Treatment is usually orthopedic (can tempt even in stages III and IV).

– Method Blount (immobilization hyperflesion)

Rigault classification Lagrange (supracondylar):

– Extension Fracture:

* Stage I: undisplaced fracture

* Stage II: displaced fracture in one plane; most often in a posterior sagittal plane

* Stage III: displaced fracture in several planes (sagittal, frontal and horizontal) with posterior tilt, translation and internal rotation. There remains a bone contact between the two fragments.

* Stage IV: fracture to large displacement without contact between the epiphyseal fragment and the shaft.

* Stage V: fracture line diaphyso epiphyseal

– Rarely (<10%) the fracture is flexed and the main epiphyseal displacement is earlier.

NB:

* Rehabilitation in children is totally useless, being exceptional stiffness even after prolonged immobilization

* Non anatomical position as possible to maintain a reduction; 3 cotton jerseys; very careful molding

* In most cases orthopedic treatment is the rule in children; avoid the use of bone plates.