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Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
Principles of fracture remodeling in children
1Department of Orthopedics, University of Texas, Health Science Center, San Antonio, Texas, USA. drwilkins@aol.com
Insights
Pediatric fractures heal rapidly with excellent remodeling capacity, making nonunion rare. Surgeons should understand bone healing phases and remodeling potential for optimal treatment of children
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pediatric Bone Healing
Background:
- Understanding the three phases of bone healing (inflammatory, reparative, remodeling) is crucial for treating pediatric fractures.
- Fracture remodeling in children depends on bone type, patient age, and joint proximity.
- Long bone fractures exhibit significant remodeling, primarily through physeal reorientation (75%) and diaphyseal apposition (25%).
Purpose of the Study:
- To outline acceptable alignment guidelines for pediatric fracture patterns.
- To emphasize the importance of understanding pediatric bone healing and remodeling.
- To guide surgeons in deciding between conservative management and aggressive techniques for pediatric fractures.
Main Methods:
- Review of bone healing phases and remodeling principles in pediatric long bones.
- Analysis of factors influencing fracture remodeling capacity in children.
- Outline of acceptable alignment values for major pediatric fracture patterns.
Main Results:
- Pediatric fractures demonstrate rapid healing and a high capacity for remodeling, minimizing the risk of nonunion.
- Physeal reorientation accounts for the majority of long bone fracture remodeling in children.
- Acceptable alignment values serve as guidelines, with patient factors and surgeon experience being critical considerations.
Conclusions:
- Surgeons must possess a thorough understanding of pediatric bone healing and remodeling.
- The excellent remodeling potential in children allows for less than anatomical alignment in many fractures.
- Treatment decisions should balance the bone's remodeling capacity with the need for potentially more invasive interventions.
Abstract:
In treating fractures in children, the surgeon must have a good knowledge of the three phases of bone healing, ie, inflammatory, reparative, and remodeling and understand how they contribute to the final recovery of the fracture healing process. By and large, the ability to remodel depends on the bone involved, the patient's age, the proximity to the joint, and its orientation to the joint axis. In the typical long bone, 75% of the remodeling occurs by reorientation of the physis while appositional remodeling of the diaphysis can only be expected to contribute 25% to the remodeling process. The various values of acceptable alignment for each of the major fracture patterns are outlined. These serve only as guidelines. The patient's functional capacity and the surgeon's experience should also be factors in determining whether to depend on the remodeling capacity of the specific fracture or to consider performing a more aggressive, invasive technique to achieve a satisfactory result. There are two advantages in treating children's fractures. First, the healing process is very rapid. Nonunion is a rare event in the pediatric age group. The second perk is that there is a very good remodeling capacity should there be less than anatomical alignment of the affected bone once the fracture has healed. Any individual treating fractures in the pediatric age group should fully understand how pediatric fractures heal and how the remodeling process occurs.
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