Pediatric Fractures: Greenstick, Torus, and Supracondylar
- Let’s talk orthopedics! Pediatric bones are highly flexible and elastic. A Greenstick Fracture is an incomplete break where the bone cracks on one side (tension side) but remains bent on the other (compression side), with an intact periosteum.
- A Torus (Buckle) Fracture is a compression injury where the pediatric cortex bulges outward, but the continuity is unbroken. These are very stable and treated with simple casting.
- A Supracondylar Humerus Fracture occurs when a child falls on an outstretched hand. This is a surgical emergency! The displaced bone fragment risks lacerating or compressing the brachial artery or the median nerve, which can lead to Volkmann's ischemic contracture of the forearm if not reduced immediately!
Adult Hip Fractures: Femoral Neck vs. Intertrochanteric
- In elderly patients falling on their side, look for hip fractures.
- Femoral Neck Fractures are intracapsular. Because their blood supply is thin (relying heavily on the ascending branch of the medial femoral circumflex artery), neck fractures carry a massive risk of causing avascular necrosis (AVN) of the femoral head, requiring joint arthroplasty.
- Intertrochanteric Fractures are extracapsular and have a rich blood supply. They rarely lead to AVN but can bleed heavily. Both present with a classically shortened and externally rotated leg on the injured side.
Malignant Bone Tumors: Osteosarcoma vs. Ewing Sarcoma
- Osteosarcoma is the most common primary malignant bone tumor in teenagers, classically arising in the metaphysis of long bones (around the knee). X-rays show a bone-destroying lesion with a "sunburst" calcification pattern and "Codman’s triangle" (raised periosteum).
- Ewing Sarcoma is a highly malignant, neuroectodermal bone tumor in children arising in the diaphysis of long or flat bones. It is caused by a t(11;22) translocation and displays a classic "onion-skin" concentric laminated periosteal reaction on X-rays.
- Giant Cell Tumor is a benign but locally aggressive tumor arising in the epiphysis in adults, displaying classic "soap bubble" lytic bone lesions on radiographs.
💡 Memory Mnemonic Aid:
S-E-R: Shortened and Externally Rotated
The classic clinical attitude of an injured limb in patients presenting with a displaced hip fracture on absolute physical assessment.
🌟 High-Yield Boards Summary Indicator:
Emergency Warning: In any child presenting with a supracondylar humerus fracture, always repeatedly evaluate the radial pulse, finger warmth, and capillary refill to prevent permanent ischemia and contracture of the limb!