Other Considerations

Comminuted fractures are less common in children because:

• A child’s ligaments are relatively lax compared to an adult’s, but they are stronger. Sprains are therefore unusual
• Instead, growth plate fractures and avulsion fractures near the ligamentous insertions are more common

The bone is more biologically active with a thick vascular periosteum so:

• Bone healing is faster in children
• Complications affecting bone healing are rarer than in adults
• The thicker periosteum usually remains intact on the concave side of the fracture
• Children’s bones remodel to a greater extent than adults’ do, and therefore a greater amount of angulation and displacement is acceptable in children.
• The exception to this is with intra-articular fractures where angulation or displacement are never acceptable.
• Rotational deformity does not correct readily in the young child and should always be avoided.

More biologically active bone and thick vascular periosteum has several implications:

• Decreases the amount of displacement of fractures
• Is probably a factor in the lower incidence of open fractures in children
• Allows manipulation under anaesthetic (MUA) to be achieved relatively easily without ‘over-correction’
• Also helps to stabilise any fracture reduction
• Stiffness of joints after immobilisation is less of a problem in children than in adults, partly because immobilisation is needed for shorter periods