A study of 2,532 fractures in children

Abstract

of the recent marked increase in the use of open reduction and internal fixation, it was believed that a study of this Iatter group wouId be a sobering inffuence and again re-emphasize the fact that “Fractures in chiIdren are different.“’ In this group of 2,058 patients there was a predominance of maIes, constituting 64.3 per cent of the total. The group sustained a total of 2,532 fractures, of which 2,093 or 82 per cent invoIved the Iong bones of the body. There were nine deaths (0.4 per cent), a11 of which were due to the severe craniocerebra1 injuries. The statistica anaIysis of this group is of particuIar interest because it is made up of patients treated in the emergency room as we11 as those admitted to the hospital; it therefore gives a reIiabIe picture of the frequency of invoIvement. The radius was the bone most commonIy fractured, being injured in 647 cases or 25.5 per cent (TabIe I.) BIount,’ Aitken,2 0deI13 and others have repeatedIy pointed out the factors which determine the principIes of fracture treated in chiIdren. Apposition and angulation, both of which are of prime importance in our concept of fracture treatment in the adult, are of much Iess significance in the chiId. The growth factor will equalize shortness due to overriding at the fracture site; and because the fracture itself acts as a stimuIus to bone growth, it is frequentIy advisabIe to have some overriding to compensate for an actual increase in the Iength of the fractured bone. This has been pointed out repeatedIy in fractures of the femur where a I cm. overlap gives the best resuhs. Angulation will aIso be corrected by the growth factor when the fracture is near the end of the bone and in the very young when anguIation is near the middIe. This of course does not mean that apposition, anguIation and aIignment shouId be completely negIected, for it is obvious that a perfect reduction in each of these spheres wiI1 result in hastened convaIescence and norma function. However, repeated manipuIation wiI1 onIy interfere with the tremendous potential for healing and for the correction of deformity which is present in this group of patients. Open reductions, except in a very specific group of cases, with the resuItant capsular adhesions and stiffness wiI1 more often produce an undesirabIe resuIt than wiI1 a poor closed reduction. However, in fractures with dispIacement invoIving the medial epicondyle of the humerus, the lateral condyle of the humerus and the radiaI neck, open reduction should be considered as the primary form of treatment to prevent marked deformity. Other operations except under individual circumstances are not justified. This is one group where you must treat the patient and not the x-ray. EpiphyseaI injuries can potentiaIIy cause growth arrest with resultant shortening. Because of this epiphysea1 injuries are often subjected to repeated manipulation which cause more damage than the original injury. Aitken2 states : “MaIposition of an epiphysis per se, is not a cause of deformity.” There are three