Musculoskeletal injury in children.

Abstract

1. Walter W. Huurman, MD* 2. Glen M. Ginsburg, MD† 1. 2. *Editorial Board. 3. 4. †Pediatric Orthopaedics, University of Nebraska Medical Center, Omaha, NE. 1. Compartment syndromes result from decreased vascular perfusion due to increased pressure in a closed osteofascial compartment. 2. Placement of ice packs is an important immediate therapy for soft-tissue injuries, but packs must be applied for at least 20 minutes. 3. More severe sprains require protection against another injury during healing. 4. Nursemaid’s elbow is a common injury and can be treated safely by the pediatrician. 5. Supracondylar fractures commonly are associated with neurologic and vascular injury. Over the past 2 decades, the number of musculoskeletal injuries sustained by children and adolescents has increased markedly. This may reflect an increasing use of motorized and high-speed wheeled vehicles among this population. Orthopedic injuries incurred while using all-terrain vehicles, inline skates, and skateboards that rarely were seen 20 years ago now are common. It is important to recognize the basic skeletal differences between children and adults; the common signs and symptoms of fractures, sprains, strains, and dislocations; and the initial treatment and stabilization of these injuries in children. A reasonable understanding of the basic physiology involved in bone growth and development is required to identify and recognize appropriate treatment for fractures in the skeletally immature individual. The patient and parents should anticipate return to as normal function as could be expected given the circumstances of a particular injury. Bone is a dynamic organ that is ever-changing and, especially in the growing child, possesses tremendous healing characteristics. The skeleton is involved in up to 20% of childhood injuries, with 18% to 30% of these occurring directly to the growth mechanism. The unique features of this organ in the pediatric population distinguish it and the treatment of its problems due to trauma from those in the skeletally mature. ### ANATOMY The outer layer of young bone, periosteum, which is thick and flexible but strong (Fig. 1⇓), often remains partially …