Fractures that are hard to diagnose in the skeleton of a child

Czech version

Authors: P. Havránek; T. Pešl; P. Vlček
Authors‘ workplace: Přednosta: prof. MUDr. Petr Havránek, CSc. ; 3. lékařská fakulta a FTNsP, Praha ; Klinika dětské chirurgie a traumatologie ; Univerzita Karlova v Praze
Published in: Prakt. Lék. 2008; 88(7): 403-407
Category: Diagnostis

Overview

Fractures in children differ from those in adults for many reasons. Besides general differences (such as body height and weight, neuro-psychological maturity of the patient and aetiology of the trauma), an important role can be seen in the biomechanical character of child bone and above all in the nature of bone growth. The anatomical appearance of growth plates at both ends of long bones (femur, tibia, humerus, radius and ulna) but at just one end of short tubular bones (metacarpals, metatarsals and phallanges) is a fundamental fact that distinguishes the adult bone from the pediatric. This particular presence of bone growth from growth plates (physes) is the reason that paediatric skeletal traumatology should be considered a subspecialization of paediatric surgery or trauma surgery or orthopaedic surgery. Another specific characteristic of the premature skeleton in children is incomplete ossification in periarticular bone regions. This is obvious in babies and small children. Thus, articular fractures and fractures-separations of the epiphyses in fully cartilaginous tissue cannot be detected by roentgenological investigation. Although a simplification, four defined fracture types can be distinguished in the immature skeleton of a child that are impossible to find in adults. Using numerous criteria for general classification of fractures (fracture line, fragment displacement, open fractures, overuse injury) it is possible to add these pediatric fractures to the classification of fractures according to fracture line shape (transverse, oblique, spiral, comminuted, impacted, etc.). These paediatric fractures are: 1. subperiosteal „torus, buckle“ fracture; 2. bowing fracture („plastic deformation“); 3. greenstick fracture and 4. physeal injury.

Key words:
physeal injury, torus fracture, greenstick fracture, bowing fracture.

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