View source for Children's fractures and epiphysiolysis

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There are some types of fractures in children that we do not see in adults. In general, we divide children's fractures into:

* epiphyseal separation and epiphyseal fracture
* bending fractures - they are treacherous, the fracture line is not visible, the bones are only bent - so-called bowing fractures
* willow stick type fractures – bone fracture without breaking the periosteum – so-called greenstick fractures
* compression, "torus" fractures

[[File:Unterarmfraktur.jpg|thumb|Willow twig type fracture - X-ray]]

== Separation of the epiphyses ==

* the growth cartilages are the weakest part of the child's skeleton (the ligaments are several times stronger, therefore there will be no [[Luxation|dislocation]] , but the epiphysis breaks)
* separation occurs mainly in the hypertrophic zone of growth cartilage, in the layer of degeneration and provisional calcification

=== Classification according to Salter and Harris ===

* '''1st type – pure separation of the epiphysis in the growth joint'''

:* there is no bony lesion, if it is not dislocated it can be overlooked
:* if the germinal layer is not affected, the prognosis is good

* '''2nd type – separation of the physis, but in a certain place there is a fracture towards the metaphysis'''

:* on x-ray we see a triangular fragment (Thurston-Holland sign)
:* there is also no growth disorder
:* type 1 and 2 are epiphysiolysis

* '''3rd type – right epiphyseal fractures'''

:* the fracture line starts at the joint, runs through the core of the epiphysis to the periphery
:* the likelihood of a bone growth disorder is significant

* '''4th type – transepimetaphyseal fractures'''

:* the epiphyseal vascular system is also often broken - growth disorders

* '''5th type – growth joint injuries caused by axial compression'''

:* with a fresh injury, the diagnosis is quite problematic

[[File:SalterHarris.svg|thumb|Classification according to Salter-Harris]]

=== Therapy ===

* children often tolerate limb injuries surprisingly well and a negative x- ray often means nothing!
* sometimes it is good to add an x-ray of a healthy limb (special – carpal bones, patella , etc.)
* conservative treatment dominates
* in general – we conservatively solve types 1, 2 and 5 (types 3 and 4, if there is no dislocation)

== Children's fractures in special circumstances ==

* birth fractures – most often the clavicle , then diaphyseal [[fractures of the humerus]] and femur
* fractures in the abused child syndrome – the child is screaming, scared, hematomas on the skin , suffusion, multiple epiphyseal separations
* pathological fractures - in benign bone affections - mainly juvenile bone cysts , non-ossifying fibroma , [[chondroma]] , etc.

== Consequences of childhood fractures ==

* most heal without sequelae
* growth plate disorders may occur
* the most common cause of bone growth arrest – the formation of so-called '''bone bridges'''

:* '''''healing bridge''''' – formed in the gap of an imperfectly repaired physis during distraction
:* '''''osteonecrotic bridge''''' – by breaking the cells of the reserve and proliferative zone as a result of a disorder of the epiphyseal arteries
:* according to the location in the bone, bridges are:
:# ''peripheral'' – axial deviation of the limb
:# ''central'' – shortening of the limb, with further growth the growth joint is deformed into a conical shape ("tenting")
:# ''combined'' – the most severe – both shortening and angulation



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== Links ==
=== Related Articles ===
* Coxa vara adolescentium
=== Source ===

* BENEŠ, Jiří. ''Study materials''  [online]. [feeling. 2009]. < http://jirben.wz.c<nowiki/>z >.

=== References ===

* Dungl, P, et al. ''Orthopedics. ''1st edition. Prague: Grada Publishing, 2005. 1273 pp.  <nowiki>ISBN 80-247-0550-8</nowiki> .

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[[:Category:Surgery|Category:Surgery]]
[[:Category:Paediatrics|Category:Pediatrics]]
[[:Category:Traumatology|Category:Traumalogy]]