Do not assume that patients have fractures without obtaining comparison views of the contralateral body part
Madan Dharmar MD
What to Do – Gather Appropriate Data
Fractures account for nearly 15% of all pediatric injuries. The anatomical, physiologic, and biomechanical differences in the bones make fractures in children different from adult fractures. Hence, children have some unique types of fractures that can be problematic to diagnose, and at the same time, their bones typically heal faster, so it is important that pediatric fractures be managed in a timely manner.
The difference in children’s bones are:
The bones are more porous and, hence, can absorb more energy before they are fractured or deformed. They have greater plasticity.
The bones have a thicker periosteum, which can help in stabilizing the fracture and can also result in faster healing. In some instances, this makes it difficult to diagnose a fracture.
In children, the long bones have growth plates or physis, which are present between the epiphysis and the metaphysis of the bone.
The bones have more cartilage than adult’s bone, which changes as children grow older. The bones are composed of perosseous cartilage, physes, and an osteogenic periosteum.
Variation in the appearance of ossification centers in the growing bone can make it difficult to diagnose fractures in children.
Children also heal differently due to their high propensity for remodeling. The factors that could affect remodeling are the age of the child, proximity to a joint, and relation of residual deformity to the plane of the joint axis of movement.
Types of fracture in children:
Complete fracture: This is the most common type of fracture, where the bone is broken on both the sides. Comminuted fractures are rare in children.
Buckle or torus fracture: They commonly occur in the metaphysic of the long bones. This fracture occurs when the bone buckles due to a
longitudinal force applied along the long axis of the bone (e.g., a fall onto an outstretched hand).
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