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Diagnosing fractures in children is often a difficult dilemma. Almost 20% of children who present with an injury have a fracture. Children will present with pain, swelling and a history of trauma. X-rays are often negative and do not always show fractures especially at the open physis (growth plate). If there is point tenderness at the growth plate, the diagnosis is made by clinical exam and the practitioner must treat the injury as if there is a fracture.
I tell parents “kids do not sprain”. The ligaments in a child are much stronger than the growth plates. The physis will yield or break before a child will tear a ligament. If improperly treated, these injuries may lead to deformity or perhaps neurovascular compromise. If in doubt, treat all swollen growth plate injuries as a fracture.
An accurate evaluation must consist of a thorough history to include the mechanism of injury), physical exam, and appropriate x-rays. Multiple views are required to visualize fracture patterns in various planes. It is imperative that the examiner remember that children are not mini adults. Children have open growth plates and because of their bones resilience they have a vast potential for remodeling. The periosteum in children is substantially thicker and more vigorous than in adults, affording more rapid healing of children’s fractures.
Practicing at Chatham Orthopedics in Savannah, GA, Mary has specialized in Orthopedic Sports Medicine for 23 years. She has presented at several national conferences and was one of the original medical professionals selected for the 1996 Centennial Olympic Games in Atlanta. In addition, Mary was selected for the 1993 US Olympic Festival, the 1995 World University Games in Fukuoka, Japan and also served on Olympic US medical teams in Sydney, Australia (2000) and in Athens, Greece (2004). Mary is the President of the Georgia Association of PAs and has served on the American Academy of Physician Assistants (AAPA) House of Delegates for several years.
Mary will be speaking at the upcoming DMGCME conferences in Las Vegas and Walt Disney World.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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