Fracture Complications in Children

 

 

Courtesy- Dr Nabil

 

 

Supracondylar Fracture of the Humerus

• Cubitus varus.
• Volkmann ischemic contracture.

Lateral Condyle Fracture of the Humerus

• Cubitus valgus.
• Nonunion.

Radial Neck Fracture

• Associated with compartment syndrome.

Midshaft Radius and Ulna Fracture

• Refracture, especially after implant removal.

Distal Ulna Physeal Injury

• Growth arrest in approximately 50% of cases.

Lower Limb

Femoral Neck Fracture

• Osteonecrosis (avascular necrosis).

Femoral Shaft Fracture (Below 5 Years)

• Overgrowth of the femur.

Femoral Shaft Fracture Treated with External Fixator

• Refracture after fixator removal.

Distal Femoral Physeal Injury

• Growth arrest in approximately 60% of cases.

Physeal Injury

• May lead to physeal bar formation.
• Growth arrest.
• Peripheral physeal bar causes angular deformity.
• Central physeal bar causes limb shortening.

Proximal Tibial Epiphyseal Injury

• Associated with vascular injury.

Proximal Tibial Metaphyseal Fracture

• Progressive valgus deformity (Cozen phenomenon).

Tibial Tubercle Fracture

• Associated with compartment syndrome.

Medial Malleolus Fracture

• Salter Harris Type IV injuries have a high risk of growth disturbance.

Distal Tibial Physeal Injury

• Rotational deformity.
• Increased external rotation of the foot.

Fracture Specific Nerve Injuries

Extension Type Supracondylar Humerus Fracture

• Anterior interosseous nerve injury.

Flexion Type Supracondylar Humerus Fracture

• Ulnar nerve injury.

Medial Pinning for Supracondylar Fracture

• Iatrogenic ulnar nerve injury.

Monteggia Fracture

• Posterior interosseous nerve injury.

Exam Pearls

Extension type supracondylar fracture

• Anterior interosseous nerve injury.

Flexion type supracondylar fracture

• Ulnar nerve injury.

Lateral condyle fracture

• Cubitus valgus.
• Nonunion.

Supracondylar fracture

• Cubitus varus.
• Volkmann ischemic contracture.

Femoral neck fracture

• Osteonecrosis.

Distal femoral physeal injury

• Highest risk of growth arrest in children.

Tibial tubercle fracture

• Compartment syndrome.

Proximal tibial metaphyseal fracture

• Progressive valgus deformity (Cozen phenomenon).