Fractures

Key points

Bone anatomy

Epiphysis: Rounded end of the bone involved in joint articulation

Diaphysis: Shaft of the bone with thick outer cortical bone and weaker inner cancellous bone

Metaphysis: Flared portion that transitions from the diaphysis to the physis

Physis: Cartilaginous zone between the epiphysis and metaphysis, crucial for longitudinal bone growth

In children fractures can significantly impact bone growth and joint development

Types of paediatric fractures

Greenstick Fracture: Cortex disrupted on one side while the other remains intact; requires reduction, often by completing the fracture

Torus (Buckle) Fracture: Incomplete fracture caused by compressive forces, typically at the metaphyseal-diaphyseal junction; managed with casting or splinting

Plastic Deformity: Unique to children, where the bone bows without cortical disruption, requiring reduction to prevent abnormal growth

Salter-Harris Classification

Type I: Transverse fracture through the physeal plate, separating the epiphysis and metaphysis

Type II: Fracture through the physeal plate extending into the metaphysis

Type III: Fracture through the physeal plate extending into the epiphysis

Type IV: Fracture crossing the physeal plate, extending through the metaphysis and epiphysis

Type V: Crush injury of the physeal plate

References

Do, Woo S, et al. "Long Bone Fractures." Pediatric Surgery NaT, American Pediatric Surgical Association, 2020. Pediatric Surgery Library, www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829861/all/Long_Bone_Fractures.