Anatomy of children's bones

• The periosteum of children's bones is very thick - bones are soft so 'bend or bow' rather than 'snap and splinter'
  • Greenstick fracture - incomplete fracture
    • Cortex on the tension side of the fracture fails but the cortex on the compression side of the fracture remains intact
  • Torus fracture - crease of the bone and periosteum
  • Plastic deformation - bad bend which stays bent, but isn't obviously fractured
• In children it is common for ligaments or tendons to avulse their soft bony attachments
• Growth plate allows for rapid healing massive remodelling potential
• Children tolerate immobilisation better (shorter rehabilitation)

The growth plate

• The growth plate (physis) is a lucency between the epiphysis and metaphysis - can appear similar to a fracture
• The physis is the weakest part of a developing bone, so is prone to injury
  • Growth plate injury may be complicated by growth deformity
  • The 'Salter-Harris' classification is used to grade growth plate fractures - prognosis is poorer as classification prgresses

Salter-Harris fractures

• In normal bones, the epiphysis is always centered on the metaphysis
• In Salter-Harris fractures, the epiphysis is not centered on the metaphysis due to a fracture involving the growth plate

Non-accidental injury (NAI)

History

• History that does not match the nature or the severity of the injury
• Vague parental accounts or accounts that change during the interview - inconsistency
• Accusations that the child injured him/herself intentionally
• Delay in seeking help
• Child dressed inappropriately for the situation

Features