Common paediatric fractures and growth-plate injury — branching viva

Branching framework

Open with the one-sentence problem representation and the growth-plate framing. A child's long bone fractures differently from an adult's because of the open growth plate, the thick periosteum and the plasticity of immature bone, and the fellowship task is to read the pattern — Salter-Harris for the growth plate, greenstick and buckle for the pliable bone, Gartland for the supracondylar — and to let the pattern decide the management. State the growth plate as the prognostic organ before you discuss any single fracture. ^{[1] [5]}

Reproduce the Salter-Harris classification and its prognosis. Type I is a pure physeal separation, type II passes through the physis and out through the metaphysis carrying the Thurston-Holland fragment and is the commonest at roughly three-quarters, type III crosses the epiphysis into the joint, type IV crosses the epiphysis, the whole physis and the metaphysis and carries the highest growth-arrest risk, and type V is a crush injury with a normal initial radiograph. Be ready for the prognosis probe — higher type, worse growth-arrest risk — and for the Peterson refinement that added further variants. ^[1]

Branch to the Gartland III supracondylar and the threatened hand. The displaced extension-type supracondylar is classified by Gartland — III is fully displaced — and it goes to theatre for emergency closed reduction and percutaneous pinning. State that the anterior interosseous nerve is the commonest nerve injured and is tested with the OK sign, and that a pale, pulseless, cold hand is reduced immediately because restoring alignment often restores the pulse, with brachial artery exploration reserved for the hand that stays white. ^[5]