Complete Physeal Separation Of Lower Humerus

Courtesy Dr Chasanal Rathod, Dr Ashok Shyam, Ortho TV

 

Definition

Pediatric fractures and injuries are classified based on:

• Mechanism of injury
• Pattern of fracture
• Involvement of growth plate
• Severity and displacement

Common Pediatric Fracture Classifications

1. Growth Plate (Physeal) Injuries

Most important in children.

? Salter-Harris classification

Types:

• Type I – Through physis only
• Type II – Physis + metaphysis (most common)
• Type III – Physis + epiphysis
• Type IV – Metaphysis + physis + epiphysis
• Type V – Crush injury of physis

2. Long Bone Fractures in Children

Based on pattern:

• Greenstick fracture – Incomplete fracture (one cortex broken)
• Torus (Buckle) fracture – Compression injury
• Plastic deformation – Bending without fracture
• Complete fracture – Both cortices broken

3. Mechanism-Based Classification

• Low-energy injuries ? simple fractures
• High-energy trauma ? comminuted fractures
• Fall-related injuries (very common in children)

4. Pediatric-Specific Patterns

• Elastic bones ? unique fracture types
• Thick periosteum ? better healing
• Remodeling potential ? high

Clinical Features

• Pain
• Swelling
• Deformity
• Reduced movement
• Sometimes child refuses to use limb

Diagnosis

• X-ray (AP & lateral views)
• Compare with opposite limb if needed
• Look carefully for:
  • Growth plate involvement
  • Subtle fractures

Management Principles

• Most fractures treated conservatively
  • Casting / splinting
• Surgical treatment when:
  • Displacement is significant
  • Growth plate involved
  • Unstable fractures

Key Points

• Always assess growth plate in children
• Mismanagement ? growth disturbances

Early diagnosis prevents deformity