Wolfgang E. Linhart

Classification and Documentation of Children's Fractures

It is absolutely necessary to classify childrens fractures for quality controls and clinical research. It is not possible that a classification of childrens fractures will follow hierarchies, such as the prognosis of growth, the kind of treatment, the severity of the lesion, the patients age, as well as medical expenditures and different techniques of therapy. The prognosis of growth is dependent on the patients age and the localisation of the fracture in the bone and in the skeleton. The kind of treatment is dependent on the extent of displacement as well as on the localisation in the bone. Thus, a classification of childrens fractures can only be characterized by the localisation of the fracture and the morphology. In addition, a parameter of “tolerable displacement” should be involved in the classification – as a sign for the possibility of spontaneous correction of displacements by further growth.From the morphological/functional point of view, the epiphyseal plate injuries should be differentiated into a metaphyseal part without proliferation but with mineralisation potential, and an epiphyseal part with proliferation but without mineralisation potential. From this aspect of functional morphology the epiphyseal separation – as a lesion in the metaphyseal part of the physis – belongs to the metaphyseal fractures (so to speak, it is the most peripheral shaft fracture), and the epiphyseal fracture – as a lesion in the epiphyseal part of the physis – belongs to the joint fractures.The localisation is differentiated into 4 main segments: upper arm, forearm, femur, and lower leg. In the segment itself, a subdivision is made into proximal, middle, and distal, with proximal and distal being further differentiated in metaphysis and epiphysis. In addition, it is possible to differentiate between radial and ulnar and tibial and fibular.The morphology is differentiated into typical fractures of the epiphysis, the metaphysis and the shaft fractures as well as avulsion fractures of ligaments, avulsion fractures of muscles and flake fractures. Exceptions in the consequent classification of morphology are only made at the distal end of the humerus and at the neck of the femur.the parameter of “tolerable displacement” showes up already known “ spontaneous corrections” of displacements in the joints, the metaphysis and the epiphysis.The proposed classification should be used in prospective clinical studies to evaluate the prognosis of growth and the results of different therapeutic approaches.

Allgemeine Gesichtspunkte zur kindorientierten Behandlung von Verletzungen

ZusammenfassungGrundlegende Unterschiede zwischen dem kindlichen und erwachsenen Bewegungsapparat, das Entstehen von Verletzungen unter dem Gesichtspunkt der Meilensteine der kindlichen Entwicklung, die Epidemiologie kindlicher Frakturen und deren Prävention sowie die Spezifität der Frakturentstehung im Wachstumsalter werden dargestellt. Die Grundsätze des Knochenwachstums nach Frakturen mit dem Schwerpunkt der stimulativen und hemmenden Wachstumsstörungen werden ebenfalls behandelt. Schließlich wird die Diagnostik sowie ein Überblick über die wesentlichen Behandlungstechniken kindlicher Frakturen gegeben. Als wesentlichstes Anliegen wird die adäquate Kommunikation für die jeweilige Entwicklungsstufe angesprochen. Dabei stellt die Respektierung des Kindes als gleichwertigen Partner und als Individuum eine Voraussetzung dar, die dem Kind im Rahmen der Behandlung vermittelt werden muss.AbstractThis report discusses the differences between the paediatric and adult musculoskeletal system. Consideration is given to preventive measures and the epidemiology and aetiology of fractures in relation to the developmental milestones in children. The principles of growth disturbances (overgrowth or growth arrest) and their management are presented. Pitfalls in diagnosis and different treatment options for paediatric fractures are discussed. Doctor-patient communication at different stages of growth and the importance of respecting the opinion of the child in management planning is emphasised.