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Fracture Principles in Paediatrics

In managing paediatric fractures it is essential to be aware of the remodeling potential of that particular fracture to assist in the management decision making process.

Fracture remodelling capacity differs significantly between the upper and lower limb, as does the remodelling potential of diaphyseal and metaphyseal fractures.

  Harris lines appear after restoration of growth following a physeal injury, the line being due to slowing of growth for a variable period following injury. If these lines are parallel to the physis then damage to growth is unlikely.

Acceptable alignment for long bones:

  1. Greater than 2 years growth remaining = 15 degrees
  2. Translation <50%
  3. Torsional deformity < 25 degrees
  4. Shortening < 15mm

Growth & Remodelling Notes:

  • Femoral overgrowth 1-2cm
  • Growth is complete by age 14 for females and age 16 for males
  • Growth is 9mm per annum in the distal femur
  • Growth is 6mm per annum in the proximal tibia
  • Modelling is best closer to the physis
  • Most remodelling of a fracture is complete by two years

Femoral Shaft Fracture - Acceptable:

  1. Shortening <15mm
  2. 20 degrees coronal angulation
  3. 30 degrees sagittal angulation
  4. No rotational malalignment


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