When it Comes to Fractures, Children Are Not Small Adults

Incorrect treatment of upper limb fractures in children and adolescents is less often caused by technical deficiencies than by a misjudgment of the special conditions in this age group, according to a new study.

Researchers at the Marburg-Gießen University Medical Center (Germany) and University Medical Center Mannheim (Germany) selectively reviewed recent publications on the main types of long bone fracture occurring in the period of skeletal development. The report stresses what should be borne in mind when diagnosing and treating fractures in children and providing aftercare, and points out possible therapeutic errors and outline strategies to avoid them.

According to the report, the main requirements for the proper treatment of fractures in children and adolescents are the immediate alleviation of pain and the provision of effective treatment, either in the hospital or on an outpatient basis, to ensure the best possible outcome, while the associated costs and effort is kept to a minimum. Further important goals are a rapid recovery of mobility and the avoidance of late complications, such as restriction of the range of motion or growth disorders of the fractured bone. To achieve these goals, the treating physician should have the necessary expertise in all of the applicable conservative and surgical treatment methods and should be able to apply them for the proper indications.

The growth that has yet to take place over the remaining period of skeletal development also has to be considered, and predicting the growth pattern of fractured bones is a basic task of the pediatric traumatologist. Particular expertise is needed to deal with fractures around the elbow, especially supracondylar humeral fractures, displaced fractures of the radial condyle of the humerus, radial neck fractures, and radial head dislocations (Monteggia lesions). These problems account for a large fraction of the avoidable cases of faulty fracture healing leading to functional impairment in children and adolescents. The review was published on December 27, 2010, in Deutsches Ärzteblatt International.

"Typical causes of therapeutic errors include imprecise diagnostic evaluation, misinterpretation of the radiograph, conservative or surgical treatment that is inappropriate for the fracture pattern, and lacking or insufficient follow-up,” concluded study authors Prof. Ralf Kraus, MD, of Marburg-Gießen University Medical Center, and Prof. Lucas Wessel, MD, of University Medical Center Mannheim.

Related Links:
Marburg-Gießen University Medical Center
University Medical Center Mannheim