From
Dr. Nelson G. Rosen
Most Common Pediatric Fractures and Prevention Strategies with Dr. Jill Larson
With Dr. Jill Larson
Chapter 1 of 9
Fracture seasonality
Introduction and Seasonal Fracture Patterns
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What the experts said
Fracture rates increase starting in March until peak in August, with a spike at Lurie Children's in October likely due to return to school with less supervision and increased athletic participation
The most common location for a pediatric fracture is the distal radius or wrist fracture
Extraphyseal fractures have a low risk of physeal growth plate arrest or damage to longitudinal growth of the arm
The closer the fracture is to the physis, the increased potential for remodeling of any residual deformity
A buckle fracture that is non-displaced heals very reliably in approximately 3 to 4 weeks depending on age
Waterproof casting must get wet daily to prevent skin excoriation
In children greater than age 10, near anatomic reduction is imperative because of the remodeling potential left in the distal forearm
Due to physeal injury, a 6 month follow-up with an X-ray is recommended to assess for physeal growth arrest
The physis in children is often the weakest part of the bone, even weaker than the ligaments or tendons themselves
A toddler's fracture (non-displaced spiral fracture of the tibia shaft) is very common in children ages 9 months to 3 years old
At ages 9 months to 3 years, children have a robust periosteal sleeve around their bones so the fracture remains very stable and heals very reliably
In children with limited verbal skills, there is a high risk of heel ulceration when the leg is placed in temporary splints
Both bone forearm fractures are at a high risk to develop compartment syndrome due to swelling from the fracture and associated soft tissue trauma
Providers should have high suspicion for compartment syndrome if a pediatric patient has increasing agitation, anxiety, and analgesic requirements after closed reduction and casting
There is an increased risk of refracture of both bone forearm fractures within the first 6 months
Flexible nailing preserves the physis to prevent any early physeal closure
Flexible nails are typically removed 6 to 12 months after healing to avoid the high risk of refracturing within the first 6 months
Fall prone activities are recommended to be avoided for at least 8 weeks postoperatively after supracondylar fracture pinning
Studies have shown that obese or overweight children are at higher risk for fracture, primarily due to the increased stress on their bones, and secondarily due to inactivity or immobility
Obese children have increased complications of fracture management due to implant failures or fracture malunions
Cast immobilization may not be sufficient to stabilize broken bones in obese children due to increasing adipose tissue
The American Academy of Pediatrics recommends 1000 mg of calcium per day and 1000 international units of vitamin D daily for ages 4 to 8 years
Each year, 200,000 children injure themselves on playgrounds in the United States
200,000 children get hurt on trampolines alone each year
More than 176,000 children ages 5 to 14 are treated each year in hospital emergency rooms for injuries related to skateboards, scooters, and skates
Most playground injuries are caused by a fall from the monkey bars onto an outstretched hand, which causes a forearm or an elbow fracture
The American Academy of Pediatrics recommends that children under 5 years old should not ride a skateboard
The American Academy of Pediatrics recommends that children younger than 8 years old should not use a formal two-wheeled scooter
Children should be at least 12 years of age or older before operating a push lawnmower, and 16 years or older to operate a riding lawnmower
The American Academy of Pediatrics guidelines state the safest course of action is to not buy or use a trampoline
Intraphyseal fractures need to be closely monitored as there can be early closure or growth plate arrest during the healing process
Recent studies have demonstrated that fracture healing rates are similar in a removable splint versus a cast
A removable splint can be applied in an urgent care setting for buckle fractures, and follow-up with a pediatric orthopedic surgeon may not be needed
Children greater than 10 years of age can have recurrence of displacement even with appropriate immobilization and should be seen within 3 to 5 days of casting
If anatomic reduction of physeal fractures is not successfully achieved on the first attempt, then treatment in the OR for closed reduction is recommended to minimize additional trauma and physeal growth arrest
Distal fibular physeal fractures should be non-weight bearing to prevent further injury to the physis
In a very displaced fracture, it is critical to assess sensory and motor function of the foot and vascular status in a timely fashion
It's important to do a reduction maneuver to take off pressure on the skin, as the bony spike can cause soft tissue or skin necrosis and ultimately lead to an open fracture
If the displacement of the joint surface in triplane fractures is more than 2 millimeters, an open reduction in internal fixation of the articular surface with a positional screw is required
Type 3 supracondylar fractures have complete disruption of the posterior cortex and are often widely displaced, which has an increased risk of neurovascular compromise
Children with vitamin D insufficiency have a fracture risk that is 3 times greater than a vitamin D sufficient child
In 2016, more than 4500 children in the United States were treated in emergency departments for injuries related to lawnmowers
Talking on a phone accounted for 69% of injuries between 2004 and 2010, and texting for 9% of injuries during the same period