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SPESIFIC FRACTURES AND

JOINT INJURIES IN
CHILDREN
Oleh: Made Dwi Pratiwi (I11111031)
Pembimbing: dr. Oktavianus, Sp.OT (K)
Spine
Fakultas Kedokteran Universitas Tanjungpura
RSAU DR. M. SOETOMO- PONTIANAK
2015

Special Features of Fractures and


dislocations in Children
1) Fracture more common
The higher incidence of fractures in
children
is
explained
by
the
combination of their relatively slender
bones and their carefree capers. Crack
or hairline fractures, buckle fractures,
and greenstick fractures are not
serious.
Intra-artricukar
fractures
and
epiphyseal plate fractures are very

2)
Stronger
and
more
active
periosteum
The stronger periosteum in children is
less readily torn across at the time of a
fracture; consequently there is more
often an intact periosteal hinge that
can be used during closed reduction of
the
fracture.
Furthermore,
the
periosteum is much more osteogenic
in children than it is in adults.

3) More rapid fracture healing


The rate of healing in bone varies much more
with age, particulary during childhood than it
does in any others tissue in the body. This is
closely related to the osteogenic activity of the
periosteum and endosteum, a process that is
remarkably active at birth, becomes progressively
less active with each year of childhood and
remains relatively constant from early adult life to
old age. Fracture of the shaft of the femur serve
as an example of this phenomenon.

4) Special Problems of Diagnosis


5) Spontaneous correction of certain
residual deformities
In adults, the deformity of a malunited
fracture is permanent, but in children
certain residual deformities tend to
correct spontaneously either by extensive
remodeling or epiphyseal plate growth,
and sometimes by a combination of both.

Angulation

6. Differences in
Complications

7. Different Emphasis on Methods of


Treatment
8. Torn Ligaments and Dislocations
Less Common

9. Less Tolerance of Major Blood Loss

Special Types of Fractures in


Children
There are two special type:
1. fractures that involve
the epiphyseal plate
The
risk
becoming
complicated by serious
disturbance
of
local
growth
and
the
consequent
development
of
progressive
bony
deformity during the
remaining
years
of
skeletal growth.

Diagnosis of Epiphyseal Plate


Injuries
Clinically in any injured child who
exhibits (signs such as local swelling
and
tenderness),
a
traumatic
dislocation, or a ligamentous injury
(including a sprain)
At least two projections at right
angles to each other are essential.

Salter-harris Classification of
Epiphyseal Plate injuries

The classification
is based on the
mechanism of
injury as well as
the relationship of
the fracture line to
the growing cells
of the epiphyseal
plate

Healing of Epiphyseal plate


Injuries
After reduction of a separated epiphysis, as in
type I, II, III injuries, endochondral ossification
on the metaphyseal side of the epiphyseal
plate is only temporarily disturbed. Within 2
or 3 weeks of replacement of the epiphysis.
Type IV injuries by contrast must healin the
same manner as any other fracture through
cancellous bone, and type V injuries usually
heal by a bony bridge across the epiphyseal
plate.

Prognosis Concerning Growth


Disturbance

Type of injury
Age of the child
Blood supply to the epiphysis
Method of reduction
Open or closed injury
Velocity and force of the injury

Possible Effects of Growth


Disturbance
85%
of
epiphyseal
plate
injuries
uncomplicated by growth disturbance

are

Special Considerations in the


Treatmentof Epiphyseal Plate Injuries
Type I dan II injuries can nearly
treated by closed reduction
Displaced type III injuries and
displaced type IV injuries always
require open reduction and internal
fixation.
The
period
of
immobilization required for types I, II,
and III injuries is only half that
required for a metaphyseal fracture
of the same bone in a child of the

Avulsion of traction epiphyses


A sudden traction force applied
through either a ligament or a
tendon to a traction epiphysis may
result in an avulsion of the epiphysis
through its epiphyseal plate.
Exampel of such injuries are avulsion
of the medial epicondyle of the
humerus and the lesser trochanter of
the femur.

Birth Fractures
During the difficult delivery of a large
baby,
especially
a
breech
presentation, when the threat of fetal
anoxia
may
necessitate
rapid
extraction of the baby, one limb may
be difficult ti disengage from the
birth canal and a bone may be
inadvertently
fractured
or
an
epiphysis separated.

Spesific Birth Fractures


Clavicle
Humerus

Femur

Spine
Fortunately, birth injuries of the spine are
rare. But they are extremely serious because
they may be complicated by complete
paraplegia

Special Fractures and Dislocations


The Hand

The wrist and forearm

Distal radial epiphysis

Distal third of radius and ulna


incomplete fractures

Complete fractures

Middle third of radius


and ulna

Proximal third of radius and ulna

The elbow and arm


Pulled
elbow
Children
of
preschool age are
particullary
vulnerable to a
sudden
longitudinal pull or
jerk on their arms
and
frequently
sustain
the
common
minor
injury

Proximal radial epiphysis


Fractureseparation of the
proxymal radial
epiphysis is
produced by a
fall that exerts a
compression and
abduction force
on the elbow
joint. Its a type
II epiphyseal
plate injury with
a characteristic
metaphyseal
fragment and
the radial head
becomes tilted
on the neck.

Dislocation of the elbow

Posterior
dislocation of the
elbow joint occurs
relatively
frequently in
young children as
a result of a fall
on the hand with
the elbow flexed.

Medial epicondyle

Avulsion of the medial


epicondyle (a traction
epiphysis) result from a
sudden traction force
through the attsched
medial ligament in
association with two types
of injuries.