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Overview of fractures

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Parts of the bone

Los huesos largos (Ej. Húmero, fémur) en el niño tienen 4 partes (Fig.1):

Long bones (eg humerus, femur) in children consist of 4 parts (Fig.1):

  • Epiphysis: ends of the bone. Covered with cartilage, in order to form the joint with another bone, thus allowing motion.
  • Physis or growth plate: organ that allows growth in length. Its closure coincides with the onset of adolescence. Growth ceases.
  • Metaphysis: Segment of bone between the physis and the diaphysis. Wider and spongier bone than diaphysis.
  • Shaft: "Reed" bone. Long central part of the bone.
     

Periosteum: membrane that covers the bone. It is thicker and richer in stem cells on the inner side than in adults. It is responsible for the growth in thickness of the shaft of the bone following a fracture. In a fracture, stem cells repair the bone forming the periosteal callus (scar repair the bone). The callus is produced more quickly and thoroughly than in adults; therefore fractures in children bind more rapidly and frequently.

CMI

1- Epiphysis

2- Physis or growth plate (arrow shows direction in which bone forming the physis is deposited)

3- Metaphysis

4- Periosteum

5- Shaft
 

Figure 1. Parts of the bone.

Bone growth and remodeling

Growth. Bone growth in length occurs due to the production of bone by the physis or growth plate. Growth in thickness is carried out by the periosteum.

Remodeling. Growing child's ability to correct deformities progressively (angles) of the bone after a fracture. It is produced by the growth of the physis and to a lesser extent the periosteum. The remodeling is more likely to happen the closer the deformity is to the physis and the younger the child is.

Owing to the ability of bone remodeling, some angulated fractures may not require treatment because they will eventually be corrected over time (Fig 2).
 


CMI

Figure 2. Metaphyseal distal radius fracture, angulated upon binding, showing a complete remodeling over time. The young age of the patient and the proximity of the fracture to the physis are factors that facilitate this phenomenon of remodeling.
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