These fractures are inherently stable and heal within 2-3 weeks with immobilization. A buckle fracture (or torus fracture) occurs due to axial compression of bone at the metaphyseal-diaphyseal junction. This is called a bowing fracture (most common in the ulna) when the bone appears to be bent without any fracture line evident. A plastic deformation occurs when the bone is bowed beyond elastic recoil, without an actual fracture. There are several configurations unique to pediatrics that may describe the fracture. The anatomic location of the fracture can be described as diaphyseal (involving the central shaft of a long bone), metaphyseal (involving the ends of the shaft of a long bone), physeal (involving the growth plate), or epiphyseal (involving the ends of a long bone). The differences between pediatric and adult fractures result in different fracture patterns, problems of diagnosis, and management techniques.ĭescription of a pediatric fracture includes the anatomic location and configuration of the fracture, as well as, the relationship of the fracture fragments to each other and to the adjacent tissue. Imperfect reductions have been known to remodel into satisfactory alignment. This feature makes children's bones more prone to buckling when compressed, or bowing when bent.įinally, remodeling is more rapid in children than in adults. Non-unions are rare in pediatric fractures.Ī third difference is the increased porosity, due to larger, more abundant Haversian canals, and decreased density of pediatric bones. The greater bone-forming potential of the pediatric periosteum results in faster bone healing in children. As a consequence, fractures in children tend to be more stable and less displaced than those seen in adults. Injuries to the growth plate may result in deformities.Īnother difference seen in children is a thicker periosteum surrounding the bones. It may separate before an adjacent joint ligament tears. It can be thought of as the "weakest link" in the pediatric bone. The growth plate is composed of cartilage. The presence of growth plates (or physes) in the pediatric skeleton is one major difference. The skeletal system of children is anatomically, biomechanically, and physiologically different from that in adults. Immobilization is accomplished with a fiberglass cast extending from the hand to the proximal humerus. A closed reduction is performed with good alignment of the radius and ulna. The patient is sedated and given additional analgesia. AP and lateral radiographs of his right forearm demonstrate displaced, angulated fractures of the radius and ulna with overriding (overlapping) ends. Radial pulses and sensation are intact.Īn IV is started and he is given 3 mg of IV morphine. Upper extremities: Swelling and deformity is observed at the right mid-forearm, corresponding to his area of greatest pain. His head, neck and torso, show no signs of external trauma. He is alert and cooperative, but subdued, in moderate pain. It is visibly swollen and deformed.Įxam: VS are normal except for a resting tachycardia secondary to pain. He reports that the pain in his forearm increases with movement. While playing soccer earlier that day, he patient fell onto his right hand and heard a snapping sound. This is a 13 year old male who presents to the emergency department with a chief complaint of right forearm pain. Case Based Pediatrics Chapter Case Based Pediatrics For Medical Students and Residentsĭepartment of Pediatrics, University of Hawaii John A.
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