Learning objectives
To define and describe paediatric “buckle” fractures.
Indicate where to look for common buckle fractures and those such fractures more difficult to identify.
Outline current management,
in light of the essentially very good prognosis,
of these fractures.
Background
Radiologists - doing any amount of paediatric plain film reporting – as well as Accident and Emergency clinicians are bound to encounter numerous "buckle" fractures on a regular basis.
Musculoskeletal injuries in the paediatric population differ on several levels from those encountered in adults due to:
the relative elasticity of a child’s bones
the presence of unfused epiphyseal plates.
Many subtle injuries can be missed if the radiologist does not make an active effort to look for them [1]:
“See what you look for –...
Findings and procedure details
Plain imaging is the initial modality of choice for the workup of trauma in children in most Paediatric and General Accident and Emergency Departments. Adjunct ultrasonographic assessment is becoming more frequent. Nonetheless,
the safe interpretation of the child’s post trauma radiograph necessitates the understanding of the different mechanics of the immature skeleton.
Fractures in the growing bones of children are subject to influences that do not apply to adult bone [2]:
Children’s bones are less brittle and more liable to plastic deformation – hence torus...
Conclusion
The patterns of musculoskeletal injuries in children are unique due to the physiology of growing bone which is unlike that of the skeletally mature individual.
Close inspection by a radiologist with a high degree of suspicion will result in the appropriate diagnosis and classification of paediatric fractures on plain radiography.
Personal information
J Muscat,
Specialist Trainee
Medical Imaging Department,
Mater Dei Hospital,
Malta
Clinical Fellow in Breast and Paediatric Imaging at BSUH NHS,
UK
[email protected]
References
Jadhav SP,
Swischuk LE. Commonly missed subtle skeletal injuries in children: a pictorial review.
Emerg Radiol 2008;15:391-398.
Solomon L,
Warwick D,
Nayagam S.
Apley’s Concise System of Orthopaedics and Fractures. 3rd Ed.
London: Hodder Arnold,
2005.
Raby N,
Berman L,
de Lacey G. Accident and Emergency Radiology – A survival guide. 2nd Ed.
London: Elsvier Saunders,
2005.
Hernandez JA,
Swischuk LE,
Yngye DA,
Carmichael KD. The angled buckle fracture in pediatrics: a frequently missed fracture.
Emergency Radiology,
2003; 10:71-75.
Randsborg PH,
Sivertsen EA. Distal radius...