Treating Pediatric Orthopaedic Fractures

Medical Professionals
6
Treating Pediatric Orthopaedic Fractures
Q
Q
Written by:
Dr. Paul Haynes,
Pediatric Ortopaedics,
Seaview Orthopaedic
Football, field hockey,
soccer, basketball,
ice-skating, wrestling,
cheerleading, etc…
The variety of sporting and recreational
activities available to
children abounds.
Mamazing energy and
arry that with their
indefatigable appetite for fun,
one can certainly understand how
their propensity for injury is elevated compared to adults. Indeed,
approximately 40% of boys and
20% of girls will experience an
injury that may result in a broken
bone. In terms of orthopaedic
injuries, children are not considered “little” adults. As such, their
orthopaedic treatment is as unique
as they are.
Q
Why are broken
bones (fractures) and
other orthopaedic injuries in
children different than those
of adults?
There a few reasons why children’s fractures behave differently
than those in the adult. Children’s
bones possess unique anatomy and
physiology, compared to adults,
that predisposes them to distinctive
injuries. At the ends of the majority of children’s bones are growth
plates. These specialized structures
allow for the bulk of longitudinal
growth – arms and legs to grow.
Growth plates are comprised of a
small, complex cluster of specialized cartilage cells that regulate and
generate skeletal growth. Because
they are made of cartilage, they are
weaker or softer than mature bone.
During an injury, energy often
finds the “weakest-link,” which
results in fractures in and around
the growth plate.
Surrounding every bone is a
thick layer of supportive tissue
– periosteum. This structure is
considerably thinner in the adult.
The robust periosteum in children
allows for accelerated bone healing
and may also help keep fractures
better aligned. The anemic adult
periosteum does not possess the
same ability to constrain fractures
from displacing (the broken bones
moving from their normal position) nor allow them to heal at the
same pace.
Lastly, as children mature,
their muscular development may
outpace their bony development.
Muscles, and their bony insertions
into bones (tendons), and ligaments (structures that often connect bones) may be stronger than
the bone they are acting on. In
adults, ligaments, muscles and tendons are usually the “weak-link.”
It is this unique arrangement that
may lead to fractures in children
as opposed to ligament, tendon or
muscle tears in adults.
What types of
fractures occur in
children?
As the growth plate is a relatively weaker structure within the
pediatric bone, it is frequently
involved in fractures. The most
commonly used classification system for growth plate fractures is
the Salter-Harris fracture classification. It accounts for the most common types of growth plate fractures
and injuries. In general, as the
growth plate fracture level in the
Salter-Harris classification is elevated from I to V, so is the potential
damage to the growth plate itself.
This may have an impact on the
bone’s or limb’s normal development.
In addition to fractures involving the growth plate, children may
incur other distinct fracture types.
As their bones are softer or weaker
than adults, children may have
buckle (torus) or greenstick fractures. In buckle or torus fractures,
one side of the child’s bone literally
buckles under pressure while the
opposite side remains intact. These
types of fractures most often occur
after a fall on an outstretched hand
within one of the bones near the
end of the forearm. Greenstick
fractures are likened to a young tree
branch being bent – one side splinters while the other side contorts.
These types of fractures often occur
in the forearm.
How are children’s
fracture treated?
Ironically, the characteristics
that make children prone to certain
types of fractures also allow them
to heal uniquely. The majority of
fractures that happen in children
are amenable to conservative treatment – casts, splints or slings.
Also, treatment times are often
reduced with fractures in children
as opposed to adults. A fracture
in the lower leg or thigh bone of
a child will often heal in a cast in
a relatively short period of time
whereas, a similar fracture in an
adult will require a lengthy time in
a cast or an operation.
Special consideration is warranted regarding fractures involving the
growth plate. There are times that
fracture in and around the growth
plate requires manipulation or surgical intervention. Manipulation
(to move the fracture fragments
into acceptable position) may be
accomplished with local but may
also require general anesthesia
in the emergency or operating
rooms. Alternatively, some fractures require an operation that will
Official Team Doctos Of:
Seaview Orthopaedic
STEVEN BERKOWITZ, M.D., P.A.
ROY D. MITTMAN, M.D., P.A.
ARTHUR P. VASEN, M.D., PH.D., P.A.
KENNETH Y. CHERN, M.D., P.A.
HARALAMBOS DEMETRIADES, M.D., P.A.
ARTHUR K. MARK, M.D., P.A.
CHRISTOPHER J. SPAGNUOLA, M.D., P.A.
HOAN-VU T. NGUYEN, M.D., P.A.
ARON M. GREEN, M.D., P.A.
SUNIL THACKER, M.D.
KEVIN C. MCDAID, M.D.
PAUL HAYNES, M.D.
JOEL FECHISIN, M.D.
ROBERT P. PANNULLO, M.D.
ADAM M. MYERS, D.O.
KEIRON GREAVES, M.D.
SUDHA GARLA, M.D.
The County Woman Magazine
Q
What types of complications can occur
with pediatric fractures?
Complications may certainly
happen with any fracture but there
is a higher likelihood of complications with fractures in and
around growth plates. The more
the growth plate is disturbed, the
higher the potential for complications. Growth plates allow for longitudinal growth – their disruption
may lead to deformity (limbs growing in a bent fashion) or for limb
length discrepancy (the opposite
limb being shorter or longer than
the injured extremity).
For this reason, fractures involving the growth plate warrant closer
and often longer observation after
injury. Approximately 2-8% of
fractures involving the growth plate
result in complications. If such a
complication arises, there are many
treatments devised to correct the
issue.
Q
What should be
done if you suspect a
fracture in a child?
& Medical Associates
Board Certified And
Fellowship Trained Physicians
secure the fracture fragments in
better position using smooth pins,
screws or thin rods. A unique treatment plan is created for each child
and fracture – this often is devised
in consultation with a pediatric
orthopedist.
Specializing in:
Spinal Surgery/Scoliosis • Hand & Upper Extremity
Total Joint Replacement • Trauma/Fracture Care
Bone Density Testing • Osteoporosis Management
Workers’ Compensation • Independent Medical Exams
Foot & Ankle • General Orthopaedics
Patriot’s Park
222 Schanck Road • Freehold, NJ
Seaview Pavilion
1200 Eagle Avenue • Ocean, NJ
Brick Medical Arts Building
1640 Route 88 West • Brick, NJ
Satellite Offices in Toms River & Lakewood
732.660.6200
www.seaviewortho.com
www.TheCountyWoman.com
A fracture will often declare
itself as pain, swelling, redness,
tenderness and/or deformity.
Immediate treatment should ensue.
An evaluation by an orthopaedic
surgeon should be sought in a
timely fashion particularly with
regards to fractures involving the
growth plate.
Dr. Paul Haynes is a recent addition
to the staff at Seaview Orthopaedic
– one of the oldest and best-known
orthopaedic groups in Monmouth
and Ocean Counties. Seaview
Orthopaedic has physicians representing many of the orthopaedic
subspecialties including: general,
adult reconstruction, foot and ankle,
hand and upper extremity, spine,
sports and pediatric orthopaedics as
well as pain management.
September/October 2011