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Fracture in dislocation in children

Salient features of pediatric bone
The immature skeleton has several unique properties that affect the management of injuries in children. These properties include thicker periosteum, soft bones, an increased resiliency to stress, an increased potential to remodel, shorter healing times, and the presence of a physis. This can lead to some characteristic fracture patterns in pediatric population.
  1. Plastic Deformation
    1. Immature bone is weaker in bending strength but absorbs more energy prior to fracture. This may result in permanent deformation of bone (without being fractured) known as plastic deformation.
    2. It is most common in forearm.
    3. Reduction (correction of deformity) is recommended, if there is >20 degrees of angulation, if a child is >4 years old and has either a clinically evident deformity or limitation of pronation & supination.
Buckle (Torus) Fracture
  1. It is so called, because of its resemblance to the base of an architectural column
  2. Most commonly occurs at the transition between metaphysis & diaphysis.
    1. Dislocations and comminuted fractures are rare in children.
Greenstick Fractures
  1. Are unique to children because immature bone is more flexible and has a thicker periosteum than mature adult bone
  2. The cortex in tension fractures completely while the cortex in compression remain intact but frequently undergo plastic deformation
  3. So it is an incomplete fracture and it is necessary to complete the fracture on the intact compression side for reduction & POP application.
  4. Distal radius and ulna is the most common site of fracture in children accounting for nearly a quarter of fracture.
  1. Remodeling Potential In Children
    Remodeling of bone is best (maximum) for metaphyseal angulation deformity and least (worst)for diaphyseal rotation deformity.
  2. Growth potential of that physis
    80% of humerus growth comes from the proximal physis. So deformity associated with proximal humerus fracture is much likely to remodel than the deformity associated with distal humerus fractures.

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