Le fratture diafisarie in età pediatrica

Abstract

In the last twenty years, the incidence of paediatric long bone diaphyseal fractures has increased, owing to changes in the daily-life activities of children. The fracture pattern is different considering the child’s age, the increasing participation in sports and the large number of children involved in car accidents or who are victims of abuse. Healing times will be different depending on age, because younger children take less time to heal. Another characteristic of developmental age is the capacity of spontaneous correction of malalignment. Deformities can be spontaneously corrected in the frontal and sagittal planes, while this is not possible for rotational deformities: this peculiarity of children decreases with age. Therefore, in the choice of therapy the child’s age and the type of fracture should be considered. The type of treatment has changed over the years from a large use of casting treatment to surgical approaches by means of instruments made specifically for the developmental age. The aim of this article is to describe the general characteristics of paediatric diaphyseal fractures of the humerus, forearm, femur and tibia and the principles of non-surgical and surgical treatment in the different age groups. Speaking about non-surgical treatment, the principles of cast application for each anatomical area are described along with the timing of the treatment and the limits of tolerated deformities. The surgical treatment consists of intramedullary osteosynthesis (using elastic nail or Kirschner wires), external fixation and in selected cases plate and screws fixation. The indications for each technique are discussed together with the basics of application and the complications.