Comminuted fractures are less common in children because:
- A childs 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
- Childrens 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