ACCEPTABILITY CRITERIA FOR REDUCTION IN PAEDIATRIC FRACTURES

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UPPER LIMB FRACTURES

Proximal humerus:

• > 11 years of age: > 50 deg. Contact < 20 deg. angulation
• < 11 years of age: relatively greater displacement and angulation can be accepted. Good to excellent long term outcomes can be expected regardless of the # displacement.

Shaft humerus:

• Internal rotation: < 15 deg
• Shortening: upto 1 to 2 cms.
• Displacement and angulation:
  • < 5 years : Total displacement, Upto 70 deg. angulation
  • 5 to 12 years: 40 to 70 deg. angulation
  • > 12 years : 50 % contact , < 40 deg. angulation

Supracondylar fracture humerus

• Anterior humeral line transecting capitellum
• Baumann angle – 70-78 deg. or equal to the other side
• Intact olecranon fossa
• Translation upto 30 %
• Rotations 20-30 degrees
• Varus/ valgus angulation not acceptable

Radius ulna

• < 9 years – 15 deg. Angulation, 45 deg. Malrotation, Complete displacement, Straightening of radius
• 9-14 years– 10 deg. Angulation, 30 deg. malrotation, Complete displacement, Some loss of radial bow

Fracture radial neck

• Younger children: 30-45 degrees
• Older Children: 15 degrees

LOWER LIMB FRACTURES

Fracture neck femur :

Only anatomical reduction is acceptable

Fracture shaft femur:

• 0-6 months of age:< 1.5 cm. Of shortening, < 30 deg angulation in varus valgus plane,< 30 deg. angualtion in AP plane
• 6 months -6 years: < 2 cms of shortening,< 15 deg. angulation in varus valgus plane,< 20 deg. anterior angulation
• 6 – 10 years< 1.5 cms. shortening, < 10 deg. varus valgus angulation, < 15 deg. AP angulation
• > 10 years< 1 cm shortening,< 5 deg. varus valgus angulation,< 10 deg. AP angulation

Fracture – separation of distal physis of femur

In Salter Harris type 1 and 2

• < 10 years < 20 deg. anterior or posterior angulation
• > 10 years Only minimal AP angulation
• < 5 deg. varus valgus angulation

In Salter Harris type 3 and 4

• Anatomical reduction and ORIF

Fracture tibial tuberosity

Only minimally displaced fractures with possible active extension of knee to 0 deg. can be acceptable. Rest require ORIF

Fracture Patella

• < 3 mm articular step off
• < 3 mm diastasis on xray
• Intact extensor mechanism

Fracture of tibia and fibula

1. Proximal metaphysis :

Closed reduction to anatomic position or slight varus is acceptable

1. Diaphysis:

1. Distal tibial fractures

• Salter Harris type I & II

(i) in patients with atleast 2 years of growth remaining: < 15 deg. of posterior angulation,< 10 deg. of valgus angulation,0 deg. of varus angulation

(ii) in patients with less than 2 years of growth remaining Angulation in all planes < 5 deg.

• Salter Harris type III & IV

< 2 mm displacement

Bibliography

1. Lovell and winter pediatric Orhtopaedics 5^thedition Morrissey and Weinstein.2001 ; ; Lippincott , Williams and Wilkins
2. . Hansen B, Grieff J. Fractures of the tibia in children. Acta

Orthop Scand 1976;47:448.

3. Shannak A. Tibial fractures in children: follow-up study. J Pedi

atr Orthop 1988;8:306.

4. Dietz F, Merchant T. Indications for osteotomy of the tibia in

children. J Pediatr Orthop 1990; 10:486.

5. Yang J, Letts R. Isolated fractures of the tibia with intact fibula

in children: a review of 95 patients. / Pediatr Orthop 1997:17:347

6. Children’s Orthopaedics, Mercer Rang , 2^ndedition; 2005; Lippincott , Williams and Wilkins
7. Rockwood & Wilkins’ Fractures In Children ; 5th Edition ; Beaty & Kasser ; Lippincott , Williams and Wilkins
8. Campbell’s operative Orthopaedics,2007; 11^thedition, S. Terry Canale , James H. Beaty; Mosby publications