Pediatric Radiology > Musculoskeletal > Trauma > General Principles of Pediatric Trauma

General Principles of Pediatric Trauma

A multitude of factors help to explain why children respond differently than adults to trauma. First, children have immature bone with open growth plates and cartilaginous epiphyses. They possess a thick, tough periosteum with incomplete mineralization of underlying bone which results in greater elasticity and a greater propensity to deform prior to breaking. As a result, complete fractures are far less common in children, whereas bending, bowing and partial fractures are much more common. Moreover, with malleable bones and open epiphyseal plates, children are far less likely to sustain ligamentous damage as a result of trauma than are adults.

Common types of bone injuries in children:

  • Elastic deformation: a momentary, non-permanent deformation
  • Bowing deformation: a deformity of bone that may or may not be completely resolved with bone remodeling
  • Torus (Buckle) Fracture: involves the buckling of one cortex
  • Greenstick fracture: an incomplete transverse fracture with fracture and periosteal rupture on the convex side
  • Salter-Harris fracture: involves epiphyseal plate
  • Stress Injury: a fracture caused by repetitive trauma
  • Avulsion Injury: a bony structural defect at a tendinous or aponeurotic insertion resulting from excess stress


Right tibial fracture with associated bowing fracture of fibula in a 5-year-old male. AP radiograph shows a complete fracture through the mid-shaft of the tibia. Note the valgus deformity. There is marked bowing of the fibula both medially and posteriorly (seen best on lateral view - not available).

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