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Fractures in Children
Aka: Fractures in Children, Pediatric Fractures
- See Also
- Epiphyseal Fracture
- Fracture
- Non-Accidental Trauma related Fractures
- Pathophysiology: Anatomical differences in children result in unique Fracture patterns
- Pediatric bone is more porous and less dense (more pliable)
- Bowing or plastic deformity
- Buckle or torus Fracture
- Greenstick Fracture
- Growth Plates (epiphsyeal plates) are weaker than ligaments, tendons and bone
- Growth Plate Fractures (Epiphyseal Fractures) are more common than sprains in children
- Periosteal bone is relatively thick by comparison
- Precautions
- See Non-Accidental Trauma related Fractures
- Types: Upper extremity Fractures and injuries in children
- ShoulderFracture
- Clavicle Fracture
- Also see Clavicle Fracture from Birth Trauma
- Humerus Fracture
- See Proximal Humerus Fracture
- See Humerus Shaft Fracture
- Consider abuse if Humeral Fracture in small children or spiral Fracture
- Elbow Fracture
- See Elbow Ossification Centers
- Supracondylar Fracture of Humerus
- Lateral Condyle Fracture
- Olecranon Fracture
- Radial Head Fracture
- Lateral epicondyle Fracture
- Caused by varus stress to supinated and extended arm
- Rare Fracture (typically Salter-Harris Fracture Type 4 requiring ORIF)
- Medial epicondyle Fracture
- Apophysis Fracture in older children
- Associated with elbow Fracture in 50% of cases
- Medial Epicondyle Apophysitis (Little Leaguer's Elbow)
- Nursemaid's Elbow (Radial Head Subluxation)
- Forearm Fracture
- Distal Radius Fracture or Colles Fracture
- Proximal radius and ulna Fracture
- Isolated ulna Fracture
- Rare in children
- Confirm radial head not dislocated (Monteggia Fracture), which requires urgent reduction
- Wrist and Hand Fracture
- Scaphoid Fracture
- Tuft Fracture (or distal phalanx crush injury)
- Types: Lower extremity Fractures and injuries in children
- Hip and Pelvis Fracture
- Pelvic Fracture
- Hip Fracture
- Femoral Shaft Fracture
- Distal Femoral Fracture
- Slipped Capital Femoral Epiphysis
- Knee injuries
- Patella dislocation
- Patella Fracture
- Tibia and fibula injuries
- Tibial spine Fracture
- Tibial tuberosity Fracture
- Proximal tibial physis Fracture
- Tibia and fibula shaft Fracture
- Toddler's Fracture
- Ankle injuries
- Distal fibula Fracture
- Distal tibia Fracture
- Foot injuries
- Lisfranc Fracture
- Fifth Metatarsal Fracture
- Management: General
- Ibuprofen or Tylenol are typically sufficient for home Analgesics
- Opioid Analgesics are not commonly needed for home pediatric Fracture management after Splinting
- Ibuprofen does not appear to significantly delay Fracture healing
- DePeter (2017) J Emerg Med 52(4): 426-32 +PMID:27751698 [PubMed]
- Management: Fracture Referral Timing
- Emergent surgical Consultation indications
- Open Fracture
- Neurovascular injury (or high risk for neurovascular injury, such as for supracondylar Fracture)
- Unreducible joint dislocation (uncommon in children)
- Urgent surgical Consultation indications
- Unstable Fracture (radius and ulna Fracture, tibia and fibula Fracture, displaced tibia Fracture)
- Salter Harris III or IV Epiphyseal Fracture (involving joint capsule or cartilage)
- Fracture-dislocation (e.g. Galeazzi Fracture)
- Routine follow-up care (1-2 weeks)
- Small, non-displaced Fractures of non-weight bearing bones
- Buckle Fractures (Torus Fractures)
- Clavicle Fractures (without tenting or vascular injury)
- References
- Majoewsky in Herbert (2012) EM:RAP C3 2(7): 3