Pediatric Fractures


About Pediatric Fractures

Growth plateGrowth plates are areas of cartilage or tissue at the ends of long bones in children. They determine the length and shape of the mature bone. 

At the growth plate, additional cartilage cells are added and turned into bone through a process called ossification. When the cartilage and growth plate ossifies, the growth plate closes and bone growth stops. 

Since growth plates are made of cartilage, they are weaker than other areas of a growing skeleton. This makes them more vulnerable to injuries, including fractures.

Pediatric orthopaedic specialists at Children's know how to properly diagnose and treat injuries to growth plates to minimize growth disturbances associated with a fracture. If an injury to a growth plate is not treated the right way, it could result in long-term complications like deformity or arthritis.

X-raysRadiation from an X-ray "shines through" a body part to create a "density shadow." The denser an object is, the brighter it looks on the X-ray. Bone is denser than cartilage or muscle, so it appears whiter on the X-ray. Cartilage, which is denser than muscle or skin, still shows up on X-rays, but not as pronounced.

Radiologists at Children's use low-dose protocols that limit the amount of radiation to which a child is exposed. This means we can see the "shadows" with 50 percent less radiation than an adult hospital.

Pediatric X-rays look different than an adult's X-ray, and not just because children are smaller. Because children's bones are still growing, there is more cartilage, especially near the joints and growth plates. Even though the bone has not completely ossified, it still has the same shape of the mature bone.

Because cartilage is not as dense as bone, it can make a child's X-ray look incomplete, like there are gaps in the bones and joints. In these gaps or voids are very important and complex parts of a child's anatomy called growth plates. If they are damaged because of a fracture, it can affect how a child grows and develops.

Not only do the pediatric orthopaedic specialists at Children's know how to identify problems in the growth plate, they know how to properly treat them, too. If treated incorrectly, fractures that affect the growth plate can have long-lasting effects. Our doctors know how to treat pediatric fractures so their impact is often felt only as long as it takes to heal.


Tillaux fracture

Tillaux fractureActive children and adolescents can often put twisting forces on their ankles by "rolling" them. This force can result in a Tillaux fracture (pronounced till-o), which is a fracture that goes through the joint and the growth plate. It is most common in children between the ages of 12 and 14, as the growth plate is beginning to close.

Symptoms of a Tillaux fracture include:

  • Severe pain in the ankle
  • Difficulty in bearing weight
  • Limp
  • Swelling
  • Bruising

Proper diagnosis is important. In a Tillaux fracture, the injury to the growth plate disrupts the ankle joint. Failure to properly treat this growth-plate injury can lead to persistent deformity in the joint and early arthritis.

These fractures can be commonly misdiagnosed as an ankle sprain. The cause of injury and appearance are very similar. Tillaux fractures are not always visible on an X-ray because a large part of the fracture goes through the growth plate, which is still cartilage. Pediatric-trained radiologists and orthopaedic specialists can identify this kind of fracture with a combination of imaging, patient history and a physical examination.

Ankle fracture repair

The treatment of a Tillaux fracture depends on the extent of the injury. Minor cases can be handled with a closed reduction. This involves the doctor placing the ankle in the proper position and then casting it.

If the fracture is out of place, surgery is necessary. The procedure to correct a Tillaux fracture involves placing a screw across the fracture site. This helps properly align the ankle joint.


Supracondylar elbow fracture

FallingWhen children fall backwards, they often put out their hands to break their falls. This can result in a few forms of fracture, one of which is a supracondylar elbow fracture (pronounced sü-pre-´kän-de-ler). This is one of the most common elbow fractures in children. It most commonly occurs in children between the ages of 6 and 9, while their bones are still thin and growing.

The fracture occurs in the humerus, one of the bones in the forearm, near the elbow in an area of thin, weak bone called the supracondylar region. It can have additional effects on the nerves, blood vessels and muscles surrounding the elbow. Symptoms of a supracondylar elbow fracture include:

  • Severe pain
  • Swelling
  • Inability to move the affected elbow

Supracondylar fractures need to be evaluated by a pediatric-trained orthopaedist as soon as possible. A specialist can help determine if any damage was done to neighboring soft tissue (blood vessels, nerves and muscles) and if compartment syndrome is a possibility. Compartment syndrome happens when there is not sufficient blood supply to a body part after an injury. It can lead to further muscle and nerve damage.

Fractured bones need to be aligned for the elbow to function properly. Misalignment can result in arm deformity and stiffness.

Supracondra fracture pinning

As with most fractures, the treatment for a supracondylar elbow fracture depends on its severity. In some cases, the pediatric orthopedic surgeon can align the bones by manipulating the elbow and placing a cast. In other cases, temporary pins are placed in the bones to maintain the proper alignment. In more severe cases, the skin will need to be cut to properly align the bones.


Monteggia fracture

Monteggia fractureA Monteggia fracture (pronounced mon-tej´ē-ă ) is another common injury that occurs when a child falls onto an outstretched hand. The fracture occurs in the ulna, one of the bones of the forearm. The force of the fall, paired with the fracture, also forces the head of the radius, the other bone in the forearm, to dislocate from the elbow joint.

Symptoms of a Monteggia fracture include:

  • Pain
  • Swelling around the elbow
  • Inability to move the affected joint

While the fracture is often easy to spot on an X-ray, the dislocation can sometimes be missed. This can result in prolonged symptoms and more complicated procedures for treatment. Pediatric specialists that are experienced in identifying a Monteggia fracture can diagnose the condition quickly so additional treatments aren't needed.

Most cases of a Monteggia fracture can be treated by gently placing the bones in the proper position and stabilizing the arm with a cast.

In some cases, the surgeon will have to use rods or plates to keep the bones properly aligned.


Femur fracture

The femur, or the thighbone, is the largest and strongest bone in the body. A sudden, forceful impact--like a hard fall on the playground or taking a hit in contact sports--is usually required to break it. Although fractures of this kind usually heal well, it is a serious injury.

Symptoms of a fractured femur include:

  • Severe pain
  • Swelling and discoloration
  • Inability to stand or walk
  • Limited range of motion in the knee or hip

Femur growth platesAs with any fracture in children, the growth plates must be taken into account. If the growth plate is damaged, deformities in the leg can result and progress with age. This can also lead to limb-length discrepancy. Treatments for this injury must be made as to not to interrupt the growth plate. Children are also more likely to have long-term bone damage and hip deformities after a femur fracture.

Femur fractureThe treatment of a fractured femur in a child depends on his age, fracture pattern and whether there are other injuries. Younger children, below age 5, are most often treated non-surgically. 

The bone is gently manipulated back into place and stabilized with either a Pavlik harness or a spica cast. In older children, surgical treatment is becoming more common. Flexible rods or nails are placed into the hollow part of the bone, avoiding the growth plate, to hold the femur together.


Tibial spine fracture

Tibial spine fractureA knee injury in active, growing children, adolescents and teens is a tibial spine fracture. This occurs when the anterior cruciate ligament (ACL) is stretched and it pulls the tibial spine (a bony ridge at the top of the tibia, or shin bone) away from the rest of the bone. This can happen when the knee is extended too far or twisted. It is more common in children because the ACL is stronger than the still-growing tibia.

Symptoms of a tibial spine fracture include:

  • Pain
  • A popping sensation in the knee
  • Swelling
  • Inability to put weight on the knee
  • Inability to straighten the knee completely

The common complications of a tibial spine fracture are knee stiffness or instability. These complications resemble those of an ACL tear or knee sprain. An X-ray or magnetic resonance imaging (MRI) scan can help diagnose the fracture properly. This is the best way to make sure the correct treatment is started.

Tibial spine fractureIf the tibial spine is not displaced, or separated from the rest of the bone, the fracture can be treated non-surgically by lining up the bone correctly and casting it. If the fracture is more severe, surgery is needed to ensure proper healing. 

In many cases, an arthroscopic procedure can be used to put the fracture fragment back into place and secure it appropriately. This procedure involves placing two pins into the knee that pull a suture over the tibial ridge to pull it into the right position. By treating the fracture this way, the surgeon is able to properly repair the fracture and avoid the doing any damage to the nearby growth plate.

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