Pediatric Bone Fractures

00:01 In this lecture, we’ll review pediatric bone fractures and in particular, some issues that children have to deal with that you don’t see so much in adults.

00:11 So let’s remember what’s unique in bones about children, they’re growing.

00:17 Here you can see a classic and this is a normal X-ray of a child’s leg.

00:21 And you can see that there’s a metaphysis, a growth plate or the physis, and then the epiphysis.

00:27 Remember, the growth occurs at the physis and is going backwards up into the metaphysis as it’s laying down new bone.

00:34 And the epiphysis is sort of going along for the ride until the growing is done and then it all grows together.

00:41 Okay.

00:42 What can happen? Kids can have fractures through their growth plate, which are at increased risk for developing growth problems.

00:51 We call these Salter-Harris fractures.

00:54 There are five types of Salter-Harris fractures and they can be easily remembered by the mnemonic SALTR, S-A-L-T-R, you got to drop the E.

01:03 The only thing you have to do with this mnemonic is draw the bones in the correct orientation, which is growing down like I showed you in that X-ray.

01:11 Okay.

01:12 Let’s go through the five types of Salter-Harris fractures.

01:16 Type 1 is slipped.

01:18 The S stands for slipped.

01:20 This is where the fracture occurs only through the growth plate.

01:24 You can’t see this on X-ray unless it’s really moved a long way.

01:29 An example where you might see it moved a long way is a SCFE or slipped capital femoral epiphysis and there’s another talk you can see here about that in.

01:38 In this case, sometimes, it’s only expressed by pain over a growth plate.

01:43 So in a child, pain over a growth plate after an injury is a Salter-Harris 1 fracture until proven otherwise.

01:52 Next, above.

01:53 This is where it goes above the epiphysis and then through it.

02:00 This you’ll see on the X-ray as a lesion above the area where the physis happened.

02:06 Now, this is why you have to draw out this way to figure out the other way types 2 and 3 get reversed.

02:10 Because the L stands for lower.

02:13 This is where it’s below the physis.

02:16 And then through is type four where it goes through both the above and below.

02:21 In other words, type 2 is a fracture through the metaphysis, type 3 is a fracture through the epiphysis, and type 4 is a fracture through both the metaphysis and the epiphysis.

02:34 What’s type 5? That’s where it’s all really thoroughly damaged.

02:38 The R can stand for rammed.

02:40 It’s where the whole end is sort of destroyed.

02:44 This is a very severe type of fracture.

02:46 Okay.

02:47 So type 1 fractures are about 5% of fractures involving the growth plate.

02:53 They have a normal X-ray.

02:55 All we have to do is immobilize them and have them follow with the orthopedics.

02:58 They may repeat the X-ray or examine the joint and decide whether this was a Salter 1.

03:03 Complications are very rare.

03:05 Kids do great.

03:07 Type 2 is the majority, that’s about 75% of fractures involving the growth plate.

03:13 Generally, what we’ll do is we’ll immobilize.

03:16 We’ll follow up with orthopedics and again complications are very rare.

03:20 Generally, the growth is preserved.

03:24 This is an example of a Salter-Harris 2 fracture of the finger.

03:29 Don’t be confused, it’s above and then through the physis and you can see that finger has become a little bit altered in terms of it’s orientation as well.

03:40 So here’s a type three fracture.

03:42 This is 10% of fractures involving the growth plate.

03:46 Remember this is going through the physis and then out the epiphysis.

03:50 This requires an immediate orthopedics consult.

03:54 It may result in chronic disability because it crosses the physis into the articular surface of the bone.

04:02 Generally, these have a favourable prognosis.

04:04 They’re unlikely to cause deformation or problems with growth but this needs to be attended to by an orthopedic specialist.

04:12 A type four is again about 10% of fractures involving the growth plate.

04:17 This requires also immediate orthopedics consult for essentially the same reason, that break into the articular surface.

04:25 And here, deformity of the joint is more likely as a long-term consequence than in type 3.

04:32 And last, type 5 fractures are very rare.

04:35 They’re usually from very severe trauma, which requires an immediate orthopedics consult, and their prognosis is poor for growth and function of the joint.

04:44 So these children can really be in trouble.