Fractures in children

Figures & data

Figure 1. Distribution of fractures by age and sex (from Paper 4). Copyright Journal of Bone and Joint Surgery [Am], reprinted with permission.

Figure 2. Measuring the sagittal displacement of distal radial fractures in children. α represents the angular displacement caused by the fracture.

Figure 3. Examples of fractures from each category. A: Buckle fracture B: Greenstick fracture C: Complete fracture D: Physeal fracture (From Paper 3). Published by BioMedCentral Musculoskeletal Disorders.

Figure 4. The Salter-Harris classification of growth plate injuries. Type I is a plain fracture through the physis. Type II includes a metaphyseal fragment. Type III is an intraarticular physeal fracture without affection of the metaphysis. Type IV has both intraarticular affection and a metaphyseal component. Type V is a compression injury of the physis. There is some controversy regarding the existence of type V.

Figure 5. Lateral angulation during the immobilization period in plaster of unreduced greenstick fractures. Note the tendency of the lateral angulation to increase throughout the period. (Data from Paper I).

Figure 6. Remodelling of a displaced complete fracture of the distal radius in a 7 year old girl.

Table 1. Limits of angulation of distal radial metaphyseal fractures that will remodel anatomically. Based on references (3;25;37;39;58;61;152)

	Sagittal plane		Frontal plane
Age	Boys	Girls
0–7	25°	20°	10°
8–12	20°	15°	5°
> 13	10°	0°	0°

Figure 7. Growth arrest of the distal radial physis following a SH Type 2 fracture in a 12 year-old girl that was initially reduced on the day of injury, and re-manipulated 3 days later due to loss of reduction.

Table 2. Mechanism of injury for 114 Gartland 2 and 3 supracondylar humerus fractures treated with closed reduction and percutaneous pining at Akershus University Hospital between 1999 and 2005

Mechanism of injury	No (percent)
Trampoline	22 (19.3)
Fall from playground equipment	19 (16.7)
Fall outdoors (unspecified)	16 (14.0)
Fall indoors (unspecified)	12 (10.5)
Bicycle	8 (7.0)
Fall from swing	8 (7.0)
Fall from tree	7 (6.1)
Fall in kindergarten	5 (4.4)
Fall from bed/sofa	4 (3.5)
Fall from horse	2 (1.8)
Soccer	2 (1.8)
Fall from fence	2 (1.8)
Unknown	6 (5.3)
Total	114 (100)

Figure 8. The Gartland classification for supracondylar humerus fractures in children. Type 1: Undisplaced. Type 2: Displaced, with intact posterior cortex. Type 3: Displaced with no bony contact between fragments.

Figure 9. Gartland 3 supracondylar humerus fracture in a 3 year old girl, managed by closed reduction and percutaneous pinning.

Figure 10. Cubitus varus after a supracondylar humerus fracture of the right elbow. The patient had no functional complaints, normal neurovascular status and had a Quick-DASH score of 0 four years after injury.

Table 3. Flynn’s criteria for grading functional and cosmetic outcome of supracondylar humerus fractures in children (34). Values are degrees

Result	Rating	Cosmetic factor: Cubitus angle loss	Functional factor: Motion loss
Satisfactory	Excellent	0–5	0–5
	Good	6–10	6–10
	Fair	11–15	11–15
Unsatisfactory	Poor	Over 15 or cubitus varus	Over 15

Table 4. Most common fractures by most common sport activity. Values are number (%). (From Paper 4) Copyright The Journal of Bone and Joint Surgery [Am]. Reprinted with permission

Sport / activity	Distal radius	Hand	Foot	Distal humerus	Clavicle	Forearm	Tibia shaft	Ankle	Other	Total
Soccer	69 (41)	42 (25)	21 (12)	7 (4)	5 (3)	6 (4)	1 (1)	9 (5)	9 (5)	169
Playground	44 (36)	6 (5)	9 (7)	23 (19)	10 (8)	12 (10)	2 (2)	3 (2)	14 (11)	123
Bicycle	38 (37)	14 (14)	2 (2)	8 (8)	9 (9)	9 (9)	6 (6)	1 (1)	16 (16)	103
Trampoline	12 (16)	8 (11)	8 (11)	19 (25)	1 (1)	6 (8)	2 (3)	4 (5)	16 (21)	76
Hand- volley- basketball	10 (14)	42 (58)	8 (11)	0	1 (1)	4 (6)	0	2 (3)	5 (7)	72
Snow sledge	17 (24)	4 (6)	3 (4)	1 (1)	23 (33)	1 (1)	7 (10)	6 (9)	8 (11)	70
Skateboard/ rollerblades	32 (48)	7 (11)	5 (8)	5 (8)	1 (1)	6 (9)	3 (5)	1 (1)	6 (9)	66
Alpine ski	10 (16)	11 (17)	1 (2)	1 (2)	10 (16)	2 (3)	11 (17)	2 (3)	16 (25)	64
Snowboard	41 (77)	1 (2)	0	1 (2)	3 (6)	1 (2)	2 (4)	0	4 (8)	53
Ice-skating	12 (43)	2 (7)	0	3 (11)	2 (7)	0	4 (14)	2 (7)	3 (11)	28
Nordic	5 (28)	3 (17)	0	1 (6)	2 (11)	1 (6)	3 (17)	3 (17)	0	18
Horseback riding	0	0	1 (8)	3 (23)	3 (23)	1 (8)	0	0	5 (38)	13
Martial Arts	2 (17)	2 (17)	6 (50)	0	1 (8)	0	0	1 (8)	0	12
Other	144 (26.9)	105 (19.6)	94 (17.5)	38 (7.1)	36 (6.7)	25 (4.7)	27 (5.0)	16 (3.0)	51 (9.5)	536
Total	436	247	158	110	107	74	68	50	153	1403

Table 5. Fracture rate estimates for common children activities. Estimates number of fractures per 10⁴ hours of activity. Confidence interval assuming Poisson distribution of fractures (From Paper 4) Copyright The Journal of Bone and Joint Surgery [Am], reprinted with permission

Activity	No (%) of active children N=794	Average hour of activity per week mean (SD)	Number of fractures	Fracture rate	95% CI
Summer activities
Handball	70 (8.8)	3.5 (2.3)	28	0.79	0.42–1.1
Skateboard/rollerblades	108 (13.6)	4.5 (10.4)	43	0.61	0.43–0.79
Soccer	301 (37.9)	5.2 (7.1)	99	0.44	0.35–0.52
Playground	170 (21.4)	6.0 (6.1)	62	0.42	0.31–0.52
Trampoline	180 (22.7)	3.8 (7.6)	35	0.35	0.23–0.47
Horseback riding	41 (5.2)	3.8 (4.9)	7	0.31	0.06–0.56
Bike	471 (59.3)	4.3 (7.0)	74	0.25	0.19–0.31
Swimming	242 (30.5)	3.1 (6.9)	0	0	–
Winter activities
Snowboard	45 (5.67)	3.3 (3.1)	27	1.9	1.2–2.6
Playground	49 (6.2)	4.3 (4.8)	15	0.73	0.35–1.1
Ice skating	164 (20.7)	1.5 (1.3)	17	0.72	0.36–1.1
Handball	82 (10.3)	3.7 (2.6)	20	0.68	0.38–0.99
Alpine skiing	245 (30.9)	2.3 (2.6)	35	0.64	0.40–0.82
Soccer	163 (20.5)	3.2 (3.1)	22	0.44	0.25–0.62
Ski (total)	595 (74.9)	3.3 (4.8)	77	0.41	0.31–0.50
Snow sledge	337 (42.4)	2.6 (2.1)	33	0.39	0.25–0.52
Nordic skiing	521 (65.6)	2.4 (4.6)	12	0.099	0.041–0.16

Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg Am 1974; 56(2): 263-72.

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