Introduction
The anatomy and biomechanics of bone in children differ from that of adults, leading to unique pediatric fractures, healing processes, and treatment. Children's bones are often less dense, more porous, and have abundant vascular supply. Therefore, they have a greater risk of developing fractures with less force and a higher risk of deformity.
What Is the Anatomy of a Pediatric Bone?
The pediatric bone has three main components: epiphysis, physics, and metaphysics. The epiphysis and joint cartilage are present at each end of the long bone. Epiphyseal plate, also called growth plate, contains cartilage cells that form solid bone with growth. Metaphysis is the bone region below the epiphysis close to the bone shaft. The bone is covered by a thick nutritive layer called periosteum. The outer layer of bone has a major significance in the healing process.
What Are Pediatric Bone Fractures?
Pediatric fractures are a break in bone continuity. When the broken bone pierces through the skin, it is called an open fracture. Fractures in children commonly occur in the wrist, forearm, or above the elbow.
Younger children develop fractures while playing or falling on an outstretched arm. Older children develop fractures while playing, riding bicycles, or in motor accidents, as children’s ligaments are stronger than adults. A force typically occurs in adults results in fractures among children due to the transfer of force to the bone.
What Are the Pediatric Fracture Patterns?
Pediatric fracture patterns are:
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Plastic Deformation: A microscopic fracture forms on the convex side of the bone and does not propagate to the concave side. The bone becomes angulated beyond its elastic limit, but the force is insufficient to produce fracture. The fracture is unique to children and cannot be visualized radiographically. The fracture is common in the ulna and fibula. If the ulna bends less than 20 degrees in a young child, it gets corrected as the bone grows.
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Buckle Fracture: It is a compressive failure of bone developing between metaphysis and dialysis.
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Greenstick Fracture: In this fracture, the bone becomes bent, and the convex side of the bone fails.
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Complete Fracture: The fracture completely propagates through the bone. It is classified as spiral, transverse, or oblique based on the direction of the fracture line.
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Physeal Fracture: The growth plate is also damaged along with the bone.
What Are the Symptoms of Pediatric Fracture in Children?
The symptoms include:
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Displaced limb or joint.
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Swelling, bruising, or bleeding.
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Intense pain.
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Tingling sensation or numbness.
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Limited mobility or unable to move.
An X-ray is needed to confirm the fracture and determine its type.
How Are Pediatric Fractures Treated?
Healthcare providers may treat with a splint or cast to prevent the displacement of broken bones and better heal the fracture. Pain is present a few days following casting, for which Acetaminophen and Ibuprofen are prescribed. Some children may need surgery along with the placement of plates, pins, and screws for the fracture to heal.
Fracture heals at different rates in children and depends on the child’s age and fracture type. For example, young children heal within three weeks, but the same fracture takes six weeks to heal in teenagers.
Why Do Limb Deformities Develop in Children After Pediatric Fracture?
Cartilage tissue at the end of bones is called growth plates and is responsible for bone growth in children. Since children's bones are still growing, an injury to the limb can lead to its shortening compared to the unaffected site. Unfortunately, 30 % of fractures in children and teenagers involve the growth plate. When the growth plate is injured, instead of regeneration of cartilaginous tissue, bone tissue forms around the injury site, creating a variation in limb length and angulation.
What Does the Recent Research Reveal About Limb Deformities in Pediatric Fractures?
According to recent studies, protein plays a major role in the healing process of children's bones. Bone morphogenetic protein (BMP) is essential for bone development and normal bone fracture healing. However, the protein's role in growth plate repair remains unknown. Some other researchers have found greater BMP levels at the site of injured growth plates. Inhibiting the BMP suppressed the bony repair of growth plates and prevented degeneration of surrounding uninjured regions.
These findings are crucial for creating a biological treatment for fractures instead of surgical. However, further research is needed to determine the exact proteins and signaling components involved in growth plate disrepair.
How to Prevent Limb Deformities After a Pediatric Fracture?
Preventing limb deformity in children following fracture is essential for properly developing the child's bone. Orthopedic researchers and developing measures to prevent long arm and limb deformities due to childhood fractures. To prevent limb deformities because of pediatric fracture, the following measure is taken:
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The caregivers must seek immediate medical attention if a fracture is suspected. Early diagnosis and treatment can prevent complications.
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The fracture limb must be immobilized with splints, casts, or braces. Immobilizations prevent the bone from being deformed.
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For complex fractures, a specialist consultation is important. Recommendations provided by the doctor on weight-bearing restriction and activity limitation must be properly followed.
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Regular follow-ups with a doctor are essential to monitor whether the fracture site is healing properly and the bones are correctly aligned.
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After removing the cast, the child must undergo physiotherapy to improve the joint's range of motion and regain muscle strength.
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A diet rich in calcium and vitamin D is advised for the child to facilitate bone healing.
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Monitor if the child is getting enough calcium and exercise, which can strengthen the bone.
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Children must be encouraged to do weight-bearing exercises like jumping rope, jogging, and walking to develop and maintain strong bones. However, preventing the child from engaging in activities that hamper the healing process is essential.
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The doctor must look for signs of infection, circulation problems, or neurovascular problems at the injury site.
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Growth plate fractures must be closely monitored with regular follow-ups to prevent growth disturbances.
Conclusion
Children have a greater tendency to develop limb deformity because of injury to the growth plate and developing bone. Although adequate treatment is provided to enable bone healing, injury to the growth plate cannot be completely reversed. Hence, researchers are finding ways to prevent this complication. Recent findings have revealed bone morphogenic protein as an effective agent to reduce its effect.
