‫بنام خداوند بخشنده مهربان‬
Epidemiology and biologic
aspects in childeren s
fractures
Epidemiology of pediatric Trauma
prerequisite
optimal care strategies
prevention strategies.
trend toward surgical intervention
Improvements in Technology
Percutaneous methods
Powered instruments
Cannulated implants,
Radiographic real time images,
Rapid Healing
minimally stabilized fracture
Minimal Hospitalization
The rising costs of hospitalization have
created a trend to mobilize children to
an outpatient setting as soon as
possible.
The Perfect Result
Epidemilogy
Of Fracture In Children
Cultural differences 
Climatic differences 
Incidence of Fractures
0 t 16 years of age:boys 42%;girls27% 
Annual 2.6%boys;1.7%girls 
1 to 2 ages high incidence of injuries(not 
fracture but injuries such laceration)
Fractures show a linear increase with 
age
gender
Males predominate in late age groups
Frist 2 years no significant gender
diffrences
Right versus Left
Predominance of left upper extermity
Season
Houres of sunshine
Younger age groups unaffected
Time of day(2-3 pm)
Age variation in fracture location
Supracondylar fx first decade,peak at age 7
Femur fx 0 to 3
Fx of physis before skeletal maturity
Single bone
Radius)Most common)
Humerus
Tibia
Specific area
Distal radius
Hand
Elbow area
Physal fx 21.7%
Open fx 2.9%
Etiology of fx
Accidental trauma
Nonacidental trauma (child abuse)
Pathological conditions
Accidental trauma
fall from height
Home environment
Social factors
School environments
Fracture rate is low
Peak time in the morning
Play and Reccreational Activities
Monkey bar Supracondylar FX risk
Hardness of the playground surface
Impact-absorbing surface such bark risk
head injury But long bone FX risk
Bicycle injury
Skates
Skate parks icrease the injury rate
Suggest Supervision &training
Motor Vehicle Accidents
Children twice adult
femoral fx
struck automobile
Recreational all-terrain vehicles
(ATVs)

Gunshot and Firearm injuries
Complication
1.Growth arrest
2.infection
Preventive Programs
Study of incidence of FX
Identify problem area
Designe decrese the risk factors
National compaigns
Local community participation
The biologic aspects of childern s
FX
Epiphysis
At brith, each epiphysis (except the distal
femur)completely cartilaginous
Secondery center of ossification
Only articular cartilage remain at maturity
physis
Metaphyseal ischemia
Epiphyseal ischemia
Metaphysis
Torus fx occur in metaphysis
Trabecular,fenestrated,compressible
cortex
Transverse lines of Park and Harris
After trauma,general illness or local such
osteomyelitis
Temporary slowdown of normal
longitudinal
Growth
Symmetrical in rapidly growing bone
diaphysis
periosteum-mediated membraneous appositional bone
formation
Endosteal remodeling
No direct muscle attachment diaphysis and metaphisis
except medial distal femoral attachment of adductor
muscles
periosteum
Thicker
Loosely attached to shaft but attach
densely into
the physeal periphery(zone of ranvier)
Apophysis
Tibial tuberosity 
Fibrocartilage instead of columnar
cartilage
Tensile responsive
Ossification of secondary ossification
center
Tend to fail to tension
Mechanisms of bone growth
Endochondral ossification 
Physis
Temporary cartilaginous tissue between
primery and secondery ossification
centers of long bone
7-9 w gestational age to skeletal maturity
15-17y
Membranous ossification 
All axial and appendicular skeletal
elements
Via periosteum