OR2.16 | Paediatric Orthopaedic Injury Patterns — Summary & Reflection

KEY TAKEAWAYS

Children's fractures are distinct from adult fractures because of the plasticity of immature bone and the presence of the physis (growth plate). Three injury groups dominate final-year orthopaedic assessment. Supracondylar humerus fractures (most common in 5-8 year olds, extension type) must trigger immediate neurovascular assessment: AIN (OK sign) for median nerve, brachial artery status (a pink pulseless hand requires urgent exploration), and signs of compartment syndrome (pain on passive finger extension is the earliest sign). Gartland classification (I: non-displaced; II: hinged; III: completely displaced) guides management from conservative to closed reduction plus K-wire fixation plus open exploration. Forearm fractures include greenstick (incomplete, plastic deformity -- the intact cortex must be broken for full reduction), both-bones fractures (closed reduction for age <10; ESIN for older children), and pulled elbow (annular ligament subluxation from traction -- reduced by hyperpronation or supination-flexion, no immobilisation needed). Salter-Harris physeal injuries (SALTR mnemonic: I = straight through physis; II = Above-metaphyseal fragment, most common, excellent prognosis; III = Lower-epiphyseal, intra-articular, needs ORIF; IV = Through all layers, always ORIF; V = Rammed compression, worst prognosis, normal initial X-ray). Types III and IV require anatomical reduction to prevent physeal bar formation and growth arrest.

REFLECT

Think about the 6-year-old in the clinical scenario at the start of this module. He has a weak radial pulse, pain on passive finger extension, and pale fingers after a supracondylar fracture. How would you sequence your clinical assessment and management from the emergency department to the operating theatre? At what point would you call the on-call vascular surgeon? And if the parents ask 'will his arm grow normally?', what would you tell them about nerve recovery versus growth prognosis in this specific fracture type -- and how would the presence of a physeal injury in the same limb change that conversation?