General principles of fracture management: Fracture patterns and description in children
- David J Mathison, MD, MBA
David J Mathison, MD, MBA
- Medical Director, Pediatric Transport Team
- Attending Physician, Pediatric Emergency Medicine
- Assistant Professor of Pediatrics & Emergency Medicine
- George Washington University School of Health Sciences
- Dewesh Agrawal, MD
Dewesh Agrawal, MD
- Associate Professor of Pediatrics and Emergency Medicine
- Children's National Medical Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic discusses the unique properties of pediatric fractures and illustrates different classification systems that exist to identify and describe them. Management of specific fractures is discussed separately and can be found by searching for the anatomic region of interest.
Common fracture patterns (eg, transverse, oblique, spiral) seen in both children and adults are discussed in detail separately. (See "General principles of fracture management: Bone healing and fracture description", section on 'Orientation: Transverse, oblique, and spiral'.)
Musculoskeletal injuries comprise approximately 12 percent of the 10 million annual visits to United States pediatric emergency departments . Skeletal fractures account for a significant proportion of these injuries and cause considerable cost and morbidity to children. Despite aggressive campaigns for injury prevention, the overall rate of fractures has been increasing [2-5].
Fractures in children exhibit unique patterns. Because of the distinctive properties of the growing bone, special attention is required to differentiate normal variants and, for the physeal fracture, to guarantee adequate healing while avoiding growth disturbance. (See 'Physeal fracture description' below.)
FRACTURE DESCRIPTION IN CHILDREN
Describing a fracture entails a thorough explanation of both the clinical scenario and the radiographic findings (table 1).
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- FRACTURE DESCRIPTION IN CHILDREN
- PLAIN RADIOGRAPH VIEWS
- FRACTURE PATTERNS
- Buckle (torus)
- Plastic deformation
- Physeal (growth plate)
- Apophyseal avulsion
- SPECIAL CIRCUMSTANCES
- Stress fractures
- Child abuse
- Pathologic fracture
- Repeat fracture
- PHYSEAL FRACTURE DESCRIPTION
- Salter I (Ogden IA-B)
- Salter II (Ogden IIA-D)
- Salter III (Ogden IIIA-D)
- Salter IV (Ogden IVA-C)
- Salter V (Ogden V)
- Ogden Type VI
- Ogden Type VII
- Peterson fractures
- AO pediatric classification