Pediatric Fractures

Fractures in children differ fundamentally from adult fractures because of the presence of growth plates (physes), the greater plasticity of pediatric bone, and the remarkable healing and remodeling capacity of growing bone. The Salter-Harris classification describes physis involvement and guides prognosis: S-H I (through physis only) and II (includes metaphysis — most common) generally have excellent outcomes; S-H III and IV (involve the articular surface) require anatomic reduction; S-H V (crush injury) carries growth arrest risk.

Pediatric bone can tolerate incomplete fractures (greenstick, torus/buckle) that are unique to children and typically heal without surgery.

X-rays in two planes. Comparison views of the opposite (normal) side are often helpful for physeal fractures. CT is added for complex articular injuries. MRI is valuable for physeal injuries and for detecting cartilaginous structures not visible on X-ray.

Surgery is indicated for displaced physeal (S-H III-IV) fractures, fractures with neurovascular compromise, unstable forearm fractures, and femur fractures in older children.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Human skeleton
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language