13. Fractures in children

This chapter systematically deals with the diagnosis and treatment of bone fractures that occur in children. A general introduction will describe the development of the skeleton. Damage to the developing children’s skeleton, and in particular to the growth plates, can have major consequences on the final shape and function of the impacted bone(s). The general treatment principles, in which a well-padded plaster cast is used after the reduction, followed by a close-fitting immobilising bandage, actually apply to all fracture treatments. Extra attention to information provided by the parents is essential here; the younger child cannot indicate when a bandage is too tight or whether, for example, a nerve is pinched. Most fractures in children, possibly after reduction, can and should be treated conservatively, because screw fixation nearby a growth plate can cause potential damage. Because children are still growing, axis deviations are often (but not always) corrected spontaneously. However, this does not apply to rotation errors and larger shaft deviations. Partly because of this, surgical fixation of fractures has been increasingly performed in recent years. By using a temporary fixation, often with K-wires, but sometimes also with plate osteosynthesis, the reduction is better maintained during the healing phase. The orthopaedic (trauma) surgeon is often the first to see children with injuries that may have been caused through child abuse. Often these fractures have specific characteristics, but alertness in general to the risk is vital.