Children are not just small adults. Growth is a factor that is central to the problems and the solutions of fracturemanagement. Growth can be an advantage by aiding in the correction of angular deformity or remodelling a fracturebut a disadvantage if growth arrest occurs. The initial work-up should eliminate the possibility of an underlyingdisease, and identify any associated injuries.Management of childhood fractures is conservative in most cases and includes reduction, immobilisation andrehabilitation. Operative treatment is limited to specific fractures. Immobilisation has to be adequate. Avoid materialwhich children can remove prematurely. Young children will easily remove short arm and short leg casts. Physicaltherapy after fracture immobilisation is sometimes required. Physical examination including neurovascular and softtissue evaluation is essential in the initial work-up of all fractures and will only be mentioned in the text if particular or special to the described fracture.To keep the chapter succinct, classifications have been kept to a minimum. For some type of fractures where one canfind more than one good classification, only one will be used in this chapter for the same practical reasons.
Growth is be a major factor in the management of fractures in children
Management is usually non-operative
The growth plateEpiphyseal fractures are potentially more severe than diaphyseal fractures because the epiphysis contains both thearticular surface and the growth plate (Figure 1: The growth plate) The growth plate is made of several different layersof cells grouped into zones:
The resting zone is adjacent to the epiphysis. Lipids and other nutritional elements are stored in this zone.The cells are sparse and the matrix is abundant. The reserve zone is avascular.
In the proliferative zone, cells multiply and matrix is formed. This zone is well vascularized.
The hypertrophic zone is divided in the zone of maturation, the zone of degeneration and the zone of provisional calcification. The chondrocytes change shape and the matrix slowly gets ready for calcification.There are complex biochemical reactions involved.Any trauma to these layers will have a potential damaging effect on it, and thus on the harmonious growth of theinvolved bone. There are several types of growth plates and the majority of them are responsible for the growth in length of the bone.The growth plate (physis) lies between the epiphysis and metaphysis in long bones. Any injury to the physis canresult in growth arrest. The different growth plates contribute a different proportion to the growth of an individual bone.In the upper extremity the majority of growth comes from the proximal humerus and the distal radius and ulna. There