1. Pediatric Trauma Intro: What makes kids so different?
OTA Resident Fracture Course

2. Top 10 reasons kids are different
Biologic activity
Periosteum
Blood supply
Remodeling
Physis
Mechanical properties of bone
Radiographic interpretation
Immobilization
Compartment syndrome
Non-accidental injury

3. 1. Biologic Activity Childhood is a time of growth and development
Machinery already “turned on”
Rate of healing  age
Non-unions rare

5. 2. The Periosteum Thicker, more osteogenic Facilitates healing
Minimizes fracture displacement
Crucial in fracture reduction

8. 3. Blood Supply Richer in kids Perfusion = healing Certain exceptions
Proximal femur
Lateral condyle

10. 4. Remodeling Allows for closed rx of many fractures Variable
Age
Distance from physis
Plane of deformity
Anatomic region
Remember: there is a limit!

11. Images courtesy of Jack Flynn, MD & Chad Price, MD

12. 5. The Physis Mechanical “weak spot” Physeal vs. ligamentous injuries
15-30% of all fractures
Contributes to rapid healing
Risk of growth arrest
Varies by anatomic region

13. Salter-Harris Classification for Physeal Fractures

14. Physeal injury can result in a growth arrest leading to
LLD or angular deformities…

15. 6. Mechanical Properties
Pediatric bones less brittle than adults
Different fracture patterns e.g. incomplete “greenstick”, torus
Plastic deformation

17. 7. Radiographs Hard to Read
Limited boney landmarks
Remember all that cartilage!
Ossification centers change with time
Contralateral radiographs, arthrograms, or MRI often useful in difficult cases

19. 8. Immobilization Generally safe Risk of stiffness low Exceptions:
older adolescents
intra-articular knee fractures
elbow fractures 9

20. 8. Immobilization Generally safe Risk of stiffness low Exceptions:
older adolescents
intra-articular knee fractures
elbow fractures 9

21. Remove any cast if there is increasing pain9

22. 9. Compartment Syndrome Harder to get reliable exam
Sentinel finding: increasing pain medicine requirements after a fracture
Often the next day
Low threshold to split cast! 9

24. 10. Non-accidental Injury
Unfortunate mechanism
Femur fx and “not yet walking”
SH II distal humerus in baby
Corner fractures
Make appropriate referrals!
3 mo old with
SH II dist hum fx 9

25. Kids can be the same… When is the “pixie dust” gone?
C-spine: age 8
Pelvis: when triradiate closes
Femur older than 12
Forearm mid teens
Elbows and knees fracture that get stiff
Displaced Intra-articular fractures

26. Questions?