Etiology and Mechanism of Injury
- Caused by compression injury leading to bulging or ‘buckling’ of the bone without complete break.
- Commonly results from axial loading, such as falling on an outstretched hand.
- Distal radius is the most frequent site.
- Pediatric bones can absorb impact and bend, contributing to higher prevalence.
Epidemiology
- Significant portion of pediatric fractures.
- Most common in children aged 7 to 12 years.
Clinical Presentation and Physical Examination
- History of fall or direct impact.
- Symptoms include swelling, tenderness, and visible deformity.
- Physical exam focuses on swelling and tenderness at the injury site.
Evaluation and Diagnosis
- Diagnosis via radiographic evaluation with two orthogonal plane X-rays.
- Characteristic buckling of the cortex seen on X-ray.
- Comparison with the contralateral limb may be used for assessment.
Management Strategies
- Immobilization with removable splints or casts for 2-3 weeks.
- Removable splints are favored for convenience and patient/parent satisfaction.
- Splints can be removed for showering but should be worn at other times, including sleep.
- Treatment aims for comfort and minimal disruption to daily activities while ensuring healing.
Differential Diagnosis
- Important to distinguish from:
- Greenstick fractures
- Salter-Harris fractures (involving growth plates)
- Toddler’s fractures
- Non-accidental injury
Sure, here’s a detailed table covering various types of fractures, their definitions, symptoms/signs, and potential complications:
| Fracture Type | Definition | Symptoms/Signs | Complications |
|---|---|---|---|
| Buckle (Torus) Fracture | Incomplete fracture where one side of the bone bends, causing a buckle without breaking the other side | Pain, tenderness, and swelling at the site of injury; often occurs in distal radius | Minimal, usually heals well; rarely leads to deformity or functional loss |
| Greenstick Fracture | Incomplete fracture where one side of the bone breaks while the other side bends, common in children | Pain, swelling, and deformity at the fracture site; may cause decreased function in the affected limb | Potential for bone deformity if not properly treated; malunion |
| Salter-Harris Fractures | Fractures involving the growth plate (physis) in children, classified into five types based on severity Type I: Transverse fracture through the growth plate. Type II: Fracture through the growth plate and metaphysis. Type III: Fracture through the growth plate and epiphysis. Type IV: Fracture through the growth plate, metaphysis, and epiphysis. Type V: Compression fracture of the growth plate. | Pain, tenderness, and swelling around the growth plate; difficulty using the affected limb | Growth disturbances, deformities, arthritis, and chronic pain |
| Toddler’s Fracture | A non-displaced spiral fracture of the tibia, typically in children aged 1-3 years | Trivial incidents like a trip or fall, often involving a twisting mechanism Limping or refusal to bear weight on the affected leg; pain and tenderness over the tibia | Mx: CAM boot, short leg cast, or splint over long leg cast Generally heals well; may cause temporary mobility issues |
| Non-Accidental Injury (NAI) | Fractures resulting from physical abuse; multiple fractures at different healing stages or unusual fracture patterns | Varying symptoms depending on the injury; may include bruises, burns, or other signs of trauma | Long-term physical and psychological effects; potential for severe disability or death |
Prognosis and Follow-up
- Excellent prognosis due to bone stability and periosteum’s healing role.
- Typically no need for X-ray or follow-up appointments post-initial treatment.
- Remove splint three weeks post-injury.
- Initial wrist stiffness and soreness are expected.
- Avoid rough play and contact sports for 6 weeks.
Complications and Patient Education
- Rare complications, including discomfort or minor skin issues.
- Removable splints have reduced complications.
- Educate parents on:
- Proper splint care
- Activity modifications
- Monitoring for complications