Another type of fracture that’s somewhat
unique to children is a greenstick fracture.
This happens because the child’s
bone is fairly flexible and pliable
and it’s result of an
Here, you can see a Colles’ fracture going
through the distal radius of this child
and what you can see from
one view, you’d say,
“Oh, that’s a simple Colles’ fracture.”
But when you look at it from the
other angle, you can see it’s broken
almost like a greenstick when you
can’t quite break it all the way.
This may require the orthopedist to
break it by bending it the other way.
We would definitely put a child to sleep
under deep sedation for that procedure
and then setting it straight
so it can heal correctly.
We usually treat these like regular
fractures with long term immobilization,
pain control, and casting and then
eventually they usually get better.
This is another type of fracture which
we would call a buckle fracture.
If you sort of imagine a hotdog
and you held the two ends
and you squeezed it together, you
get a little bulging in the middle,
that’s a buckle fracture.
You can even see it on the
view where it’s more subtle.
There’s a little bit of subtle increase
in the size of the wrist of the bone,
right around the wrist where that fracture
is if you trace the sides of the wrist.
For this, we’re going to
immobilize, provide pain control,
and have them followup with
an orthopedist for casting.
We don’t usually cast right away.
The reason why we don’t cast
right away as there may be some
continued increased swelling,
so first we’ll splint.
The splint allows for a little
bit of swelling out the sides
and then we’ll cast later.
Another type of pediatric fracture
is the apophyseal avulsion fracture.
Avulsion fracture happened because the
tendon of a muscle is inserted in the bone
and through vigorous exercise,
that insertion point gets
pulled off the edge of the bone.
The apophysis is torn off by the
muscle after repeated overuse.
This is classic in the
anterior superior iliac crest.
This happens more in
swimmers and runners.
And in the tibial tubercle,
as you can see here,
this is consistent with
Osgood Schlatter’s disease.
This is more common in jumpers and runners.
Usually athlete’s common problem
and you can see the end of
the apophysis pulling off.
Another fracture that we should know
about because it can be hard to see
is the supracondylar fracture
of the distal humerus.
It’s hard to see because, well,
the elbow’s hard to appreciate,
but there’s a phenomenon that
can happen with a fat pad,
which you normally not see.
It slips out and you see a little bit of
a darkened lucency outside of the bone.
This requires an immediate
So this is a subtle finding you
have to get used to seeing,
but it’s very important
to call an orthopedist
because these are a great risk for
harming the neurovascular bundle
that goes past the elbow.
So it’s very important that these
patients are stabilized, immobilized,
and orthopedics sees them
and oftentimes they’ll just
take them straight to the OR
to correct this
One final common pediatric fracture you don’t
see in adults is the toddler’s fracture.
Yes, this happens in toddlers.
Very young kids who are walking
and it’s a spiral fracture of the
distal tibia as you can see here.
It’s usually a little line going
diagonally down the bone.
Usually, there’s no story of trauma
and of course, in a child with a
broken bone with no history of trauma,
we would worry about child abuse.
But this is not child abuse.
What’s happened is the child was stepping and
then forcefully quickly turns on one leg,
causing a twisting and a
torsing of that tibial area
where you get that tibial fracture.
Again this is not a sign of child abuse.
It’s common in toddlers.
So that’s my review of the important
aspects of pediatric fractures.
Thanks for your time.