Pediatric Fractures Of The Lower Extremity Review - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the pediatric growth plate fracture of the lower extremity injuries.
Look for avulsion fractures of the pelvis. Pediatric pelvic fractures are usually treated conservatively. If the patient is young, the fracture is usually treated by hip spica. Watch injury to the triradiate cartilage. The cartilage may close prematurely and the hip may sublux especially if the injury occurs before 10 years of age.
Fracture femoral neck needs to be fixed. Screw placement across the physis Is acceptable in children with hip fractures. There is a high rate of AVN. A displaced hip fracture requires fixation-surgery is needed.
If fracture of the femoral shaft occurs before walking age of the children, suspect child abuse. The most important aspect is treatment. From 0-6 months use Pavlik harness. From 6 months to five years use a pelvic spica cast. From 5-11 years, flexible rod may be used. Flexible rod is used when the patient weighs less than 110 pounds, when the patient is 11 years old or younger, and when the fracture is located in the middle diaphysis, transverse or short oblique. A submuscular bridge plate is used for comminuted fractures. An intramedullary rod may be used in older patients with a trochanteric entry.
If avascular necrosis is bilateral and the child is young, it is probably Gaucher’s disease. It affects the resting zone. If you have one side involvement, then it is probably Legg-Calve-Perthes disease (LCPD). Multiple epiphyseal dysplasias may mimic LCPD but it is usually bilateral. Leukemia affects children and may cause AVN. If slipped epiphysis is unstable (Cannot do weight bearing), then there is 50% chance of AVN occurring. Fracture hip in children may cause AVN. Rod placement for femur fracture in young children which injuries the medial femoral circumflex artery may cause AVN. Rod placement for femur fractures in young children which injures the medial femoral circumflex artery may cause AVN. Usually, the injured leg is longer if the fracture occurred between the age of 2-10 years. Sometimes there may be shortening of the injured extremity if the fracture shortened significantly during the spica treatment.
Distal femur physeal fracture. Fracture generally propagates through multiple layers of the physis. There is high risk of premature growth arrest that frequently causes deformity. These growth disturbances can occur in up to 60% of the patients. If growth arrest occurs in the middle of the physis, there could be a leg length discrepancy. If growth arrest occurs at the periphery, there could be an angular deformity.
In treatment of distal femur physeal fractures, the treatment is usually closed reduction, percutaneous pinning and casting. If the fracture is Salter-Harris type III or type IV, then reduce the articular surface and fix it with screws.
Sleeve fracture occurs between the cartilage sleeve and the main part of the patella. Sleeve fracture of the patella will require surgery with a tension band or a modified tension band technique. Differential diagnosis is Bipartite patella, usually occurs in the superolateral aspect of the patella. Leave it alone. It may require lateral release if symptomatic.
Proximal tibial fractures: 1-Tibial spine 2-Tibial tubercle 3-Proximal tibial epiphyseal fracture 4-Proximal metaphyseal tibial fracture
Tibial spine fractures similar to an ACL injury in adults.
Tibial tubercle: if it is displaced, do ORIF. Watch out for injury to the anterior tibial recurrent artery due to risk of compartment syndrome. The presence of compartment syndrome is usually found due to increased analgesic requirements.
Tibial tubercle classification: •Type I: fracture of the secondary ossification center. •Type II: fracture at the junction of the primary ossification center. •Type III: fracture extends to the primary ossification center. Treatment: open reduction and internal fixation.
Toddler fracture: Nondisplaced spiral or oblique tibial shaft fracture. Patient may refuse to bear weight. X-rays may appear normal and be unable to walk. Treatment: get an internal oblique view x-ray and cast the child.
Ankle fracture: fusion of the ankle growth plate is unique. It starts in the middle and goes to the medial and then to the lateral.
Tillaux fracture: the lateral portion of the growth plate is open and when an avulsion of the anterior inferior tibiofibular ligament occurs, the condition is called tillaux fracture. If there is a displacement of more than 2 mm, do surgery.

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