Children present with different injuries than are commonly seen in adults. Because ligamentous attachments are stronger than bony attachments in children, fractures are more prevalent than sprains, dislocations, and strains. This chapter discusses musculoskeletal injuries that are unique to the pediatric population.
The following terms are typically used in pediatric orthopedics:
- Physis: The cartilaginous growth plate that appears lucent on radiographs.
- Epiphysis: A secondary ossification center at the ends of long bones that is separated by the physis from the remainder of the bone.
- Apophysis: A secondary ossification center at the insertion of tendons onto bones.
- Diaphysis: The shaft of a long cortical bone.
- Metaphysis: The widened portion at the ends of a bone adjacent to the physis.
It is important to carefully palpate the uninjured extremity first in order to obtain the child's confidence. It is also important to determine whether the history that is given by the parents or guardians is consistent with the observed injuries or whether there is a suggestion of child abuse.
A fracture may be difficult to find in an injured extremity in a child who is crying. On physical examination, palpation of areas that are not fractured will generally hurt less than areas that are injured. Palpation should be gentle, but with enough pressure so as to make a comparison between the normal and abnormal region in a child who is upset.
Neurologic evaluation of the extremity is often difficult. A generalized withdrawal response can be evaluated by using pinprick. Wrinkling of skin suggests that the nerve is intact. In assessing the vascular status of the extremity, palpation of pulses may be difficult because of the subcutaneous fat and therefore it is important to assess and document capillary refill time.
When performing plain radiographs of children, at least two views that are perpendicular to one another must be obtained. In addition, views of the entire extremity including both joints at the end of the long bones are integral to the patient's evaluation. Comparison views are invaluable, particularly when looking for a subtle fracture. The growth plates in comparison views taken in exactly the same position should be closely evaluated. Anterior and posterior fat pad signs will help identify subtle fractures (Fig. 6–1). The epiphyseal centers can often be a challenge when reading plain films and therefore it is imperative that the practitioner knows when these centers begin to appear (Fig. 6–2).
A subtle Salter III fracture of the elbow is shown on the lateral view. Notice the anterior fat pad and posterior fat pad.
The epiphyseal regions at ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessEmergency Medicine Full Site: One-Year Subscription
Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.
Pay Per View: Timed Access to all of AccessEmergency Medicine
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.