Pediatric Orthopedic
Fractures
Dafina Good, MD
Pediatric Emergency Medicine Fellow
Emory University School of Medicine
Children’s Healthcare of Atlanta
Objectives
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Review unique structural and physiologic
differences between children and adult skeletal
systems
Review fracture patterns unique to children
Review the Salter-Harris classification of
pediatric physeal fractures
Review common presentations and EPONYMS
of common pediatric and adult fractures
Review Ottawa ankle and knee criteria
Epidemiology
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Orthopedic trauma accounts for 10-15% of ED
visits in urban pediatric hospitals
It is estimated that over 40% of boys and over
25% of girls will sustain a fracture during
childhood
Rapid growth of organized sports
Skeletal Differences between
Children and Adults
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Presence of Growth Plates (Physis)
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Presence of Secondary Ossification Centers (Epiphysis)
Rapid healing
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Growth plate injuries constitute up to 25% of all skeletal injuries in
children
More metabolically active periosteum in children
Greater Potential to Remodel
More porous and more pliable bones
Fracture patterns unique to children
Fractures are more common than sprains in young children
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Ligaments and tendons attaching one bone to another have greater
strength than immature bones
Normal Bone Anatomy
Normal Bone Anatomy
Describing Fractures
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Open vs. Closed
Location (shaft, through growth plate etc.)
Displacement in mm
Shortening in mm
Impaction if present
Angulation, degree and direction (midshaft-direction of
terminal fragment)
Salter Harris Classification
Neurovascular status
Describing Fractures
Describing Fractures
Salter Harris Classification
Fractures Unique to Children
Buckle or Torus Fractures
Fractures Unique to Children
Greenstick Fractures
Fractures Unique to Children
Greenstick
Fractures
Fractures Unique to Children
Bowing Fractures
Fractures unique to children
Fractures unique to children
Toddler’s Fracture
Common Fracture Eponyms
Who Named It?
From the neck down to the toes!
Jefferson Fracture
Hangman’s Fracture
Teardrop Fracture
Chance Fracture
Boxer’s Fracture
Hand Anatomy
Bennett’s Fracture
Colle’s Fracture
Smith’s Fracture
Nightstick Fracture
Monteggia Fracture
Monteggia Fracture
Galeazzi Fracture
Supracondylar Fracture
Ossification Centers – C-R-I-T-O-E
Approximate age of appearance
Capitellum - 1 year
Radial head - 3 years
Internal epicondyle
(Medial epicondyle)-5 years
Trochlea - 7 years
Olecranon - 9 years
External epicondyle
(Lateral epicondyle)-11 years
Proximal Humeral Fracture
Slipped Capital Femoral Epiphysis
SCFE’s Klein’s Line
Klein’s Line
Pelvic Avulsion Fractures
Common Locations of Pelvic
Avulsion Fractures
Spiral Femur Fracture
Osgood Slater Disease vs Sinding Larsen-Johansson
Patellar Fracture
Knee Anatomy
Knee Anatomy
Ottawa Knee Rules
Characteristics of Patients Who Should Undergo
Radiography After Knee Trauma
Ottawa knee rules
Age 55 years or older
Tenderness at head of fibula
Isolated tenderness of patella
Inability to flex knee to 90 degrees
Inability to walk four weight-bearing steps immediately after the injury and in
the emergency department
Pittsburgh decision rules
Blunt trauma or a fall as mechanism of injury plus either of the following:
Age younger than 12 years or older than 50 years
Inability to walk four weight-bearing steps in the emergency department
Corner Fracture
Bucket Handle Fractures
Maisonneuve Fracture
Tillaux Fracture
Tillaux Fracture
CT Scan of Tillaux Fracture
Triplane Fracture
Triplane Fracture
What’s the Difference?
Anatomy of the Fifth Metatarsal
Ottawa Ankle Rules
Reasons to Refer to Orthopedics
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Open Fractures
Unacceptably displaced fractures
Fractures with associated neurovascular compromise
Significant growth plate or joint injuries
Pelvic/Femur fractures (other than minor avulstions)
Spinal Fractures
Dislocations of major joints other than shoulder/knee
Clavicle (distal third)
Fractures prone to Nonunion/Malunion
Why do we do it?
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Prevent Growth arrest
Prevent malunion or nonunion
Restore function as close to physiologic