Bowing fracture
- Epidemiology. Bowing fractures are almost exclusively found in children. ...
- Clinical presentation. Children present with pain and swelling following a fall, usually on an outstretched hand. ...
- Pathology. When an angulated longitudinal force is applied to a bone, the bone bends. ...
- Radiographic features. ...
- Treatment and prognosis. ...
Full Answer
What are the symptoms of a cracked elbow?
- You have swelling at or near the elbow.
- You notice any deformity of the elbow or the areas near the elbow.
- If you have any doubts, compare your injured elbow to your uninjured one. ...
- You hear or feel grinding, popping, or clicking as you move your elbow, wrist, or hand.
- Your elbow "catches" at the joint.
- Your normal elbow motion becomes limited.
How do broken bones heal themselves?
The healing process of a broken bone has three stages:
- Inflammation
- Bone production
- Bone remodelling
What is a posterior wall fracture?
Posterior wall fractures are often characterized by an additional posterior or posterior-cranial dislocation of the hip joint. The bone injury consists of one or more variable-sized fragments and can be associated with marginal impaction zones.
What causes a brittle fracture?
Is brittle fracture of plastic products the reason?
- Insufficient injection and packing pressure of injection molding machine;
- The back pressure is too small and the raw materials are not solid enough;
- If the back pressure is too high, the heat of shearing and friction will increase;
- The rate of fire is too slow to crystallize sufficiently;
What causes bowing fracture?
Bowing fractures usually involve the forearm, but can also occur in the tibia, fibula, and femur. The usual cause is a fall onto an outstretched hand, resulting in axial compression and multiple microfractures. The bowing of one bone is often associated with a diaphyseal fracture of the other.
What are bowing fractures?
Bowing fractures are incomplete fractures of tubular long bones in pediatric patients (especially the radius and ulna) that often require no intervention and heal with remodeling.
What is radial bowing?
The lateral curve is also called the Radial bow. It is the most important curve. The Radial bow plays an important role in supination and pronation [5] of the forearm where the Radius rotates around the fixed Ulna.
What do you do for a buckle fracture?
Buckle injuries are treated by wearing a removable backslab (a partial cast held in place with bandages) or ready-made splint, which should be worn as much as possible but can be removed for bathing or showering. An arm sling is optional, and may help reduce any pain or discomfort.
How long does it take for a bowing fracture to heal?
Recovery. The length of time the cast is worn will vary depending on the severity of the fracture. A stable fracture, such as a buckle fracture, may require 3 to 4 weeks in a cast. A more serious injury, such as a Monteggia fracture, may need to be immobilized for 6 to 10 weeks.
What are the types of fractures?
Types of FracturesStable fracture. The broken ends of the bone line up and are barely out of place.Open (compound) fracture. The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. ... Transverse fracture. ... Oblique fracture. ... Comminuted fracture.
What is a bone buckle?
A buckle (or torus) fracture is a type of broken bone. One side of a bone bends, raising a little buckle, without breaking the other side of the bone.
What is a green stick fracture?
A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks similar to what happens when you try to break a small, "green" branch on a tree. Most greenstick fractures occur in children younger than 10 years of age.
What is another term for an incomplete fracture?
In fracture. An incomplete, or greenstick, fracture occurs when the bone cracks and bends but does not completely break; when the bone does break into separate pieces, the condition is called a complete fracture.
Is a buckle fracture worse than a break?
Symptoms. A buckle fracture causes a lot of acute pain. The pain may subside if the injured limb is protected. By definition, a buckle fracture is a stable fracture and stable fractures are less painful than unstable fractures.
Does a buckle fracture need a cast?
Buckle fractures are non-displaced stable fractures, meaning that the bone did not move. They can be treated with either a wrist splint or a short arm cast, both of which give the fracture the protection it needs to heal.
Can a buckle fracture get worse?
Worsening symptoms: If a buckle fracture isn't treated by a healthcare provider, your child's symptoms like pain can get worse over time. This will also make it take longer for them to heal.
Is a buckle fracture a stress fracture?
Stress fractures (hairline fractures): Tiny cracks form in the bone, usually as a result of overuse or repetitive stress-bearing motions. Stress fractures are common in children who run track or participate in gymnastics or dance. Torus or buckle fractures: One side of the bone bends (buckles) upon itself.
Is a compression fracture a break?
A compression fracture is a type of broken bone that can cause your vertebrae to collapse, making them shorter. This often happens to the front of the vertebrae but not the back, causing you to stoop forward over time.
What's a buckle fracture of the wrist?
What is a buckle fracture? A buckle fracture occurs when a bone “buckles”, or slightly crushes in on itself. The most common type of buckle fracture in children occurs in the forearm, near the wrist, usually after a child falls onto an outstretched arm. The injury affects the radius bone in particular.
What is a Transchondral fracture?
A transchondral fracture is a fracture of the articular surface of a bone, produced by a force transmitted from the articular surface of a contiguous bone across the joint and through the articular cartilage to the subchondral trabeculae of the fractured bone.
What is the bowing of one bone?
The bowing of one bone is often associated with a diaphyseal fracture of the other. The resulting plastic deformation presents as an exaggerated curve. The child usually reports diffuse pain and shows deformity and limitation of supination and pronation. Comparison views of the uninvolved forearm may aid diagnosis.
Can plastic bowing fractures occur in children?
Two case reports and a brief discussion provide a practical review of plastic bowing fractures. These uncommon fractures occur almost exclusively in children; if missed and untreated, significant deformity may ensue.
How old should a child be to reduce bowing fracture?
The potential to remodel bowing fractures is considered important in children younger than 4 to 6 years. Therefore some authors advise no reduction at all. 4,5,10 Others reduce only deformities greater than 20°. 2,15,17,19,25 In children between 6 and 10 years old. There is no agreement concerning the need for reduction given the diminishing remodeling potential. A few recommend no reduction at all. 8,18,20 Others advise reduction for deformities greater than 20° in children between the ages of 6 and 10 years, and most advise a reduction in case of obvious clinical deformity or significant limitation of forearm rotation. 2,4,5,10,15,19,25
How long do you wear a bowing cast?
All patients wore a cast for 4 to 8 weeks with an above-elbow cast during the first 4 weeks of this period. The duration of the immobilization depended on the age of the patient and on the severity of the associated lesions. After immobilization, all patients were prescribed exercises for at least 2 weeks.
What happens to a bone when compression is applied longitudinally?
If compressing forces are applied longitudinally to a curved tubular bone, the bone deforms elastically. After this reversible phase of elastic deformation, but before the bone actually breaks, it deforms plastically. Because of microfractures, a curvature remains when the force is removed 4–6,24 ( Fig 1 ). The most commonly affected bones are those of the forearm, and the peak incidence is between 6 and 10 years of age. 5,19,23 Twenty-five percent of the current patients were diagnosed only during the treatment of the associated lesions. This suggests that this lesion is more frequent than one would expect. 5,10,12,14,15 For many authors plastic deformation of forearm bones in children always results from compression longitudinal to the axis of the bone. 1,4–6,8,11,14,16,22 Because distal metaphyseal fractures are attributable to shearing forces, the association with such distal fractures is considered impossible. 2,4,5,8,10,11,14,18 This is doubtful for several reasons. First, a transversal force most often plastically deforms the forearm bones of adults and the fibulas of children. 3,9,13,15–18,20,22,23,25 Furthermore, in Patients 5 and 10 ( Tables 1, 2 ), the mechanism of injury strongly suggests a transversal force. Therefore it is acceptable that plastic deformation of the forearm bones can result from a transversal force. The existence of two cases with an associated fracture of the distal metaphysis (Patients 5 and 7) refutes the statement that bowing fractures only can be associated with shaft fractures.
What were the problems with the forearm rotation in patients 8 and 11?
In Patients 8 and 11, these problems more likely were related to the associated distal radioulnar dislocation than to the bowing. Despite the cosmetic deformity in one patient and the problems with forearm rotation in three others, all the patients said they were satisfied with the overall result.
Is there a fracture line visible?
No fracture line is visible. The recommendations in the literature regarding reduction are variable and confusing especially for patients between 4 and 10 years of age, the group with the highest incidence. The potential to remodel bowing fractures is considered important in children younger than 4 to 6 years.
What fractures result in bowing?
Incomplete insufficiency fractures result in bowing, especially of tibia & femur
What is tibial bowing?
Tibial bowing refers specifically to (typically unilateral) congenital or infantile tibial diaphyseal deformity characterized by direction of apex
When does tibial bowing occur?
Lateral tibial bowing is a normal physiologic variation during the first year of life. It reaches its maximum angulation between 18 and 36 months, in association with physiologic bowing of the entire lower extremity. Treatment is observation to differentiate this condition from pathologic conditions, especially infantile tibia vara.
What is FIGURE 5.9?
FIGURE 5.9. Bending deformities in juvenile femora resulting from vitamin D deficiency rickets. Note unilateral difference in severity of deformity in (a) and different apex of anterior bend at distal shaft in (b) and at proximal shaft in (c). There is also distal metaphyseal flaring and coxa vara of the femoral neck in (a). Femora: (a) (b) from Medieval East Smithfield Black Death cemetery, London. Juvenile aged approximately 5 years (MIN11415).
What is long bone bending deformity?
Long bone bending deformities and metaphyseal swelling are characteristic and well-recognised skeletal changes of rickets, although there are a number of conditions where one or the other feature can occur (see differential diagnosis in later description) (see Figures 5.9, 5.10 and 5.11 ). There can be considerable variation in the manifestations of bending between affected limbs and between individuals as demonstrated in tibiae shown in Figure 5.10, with post-Medieval cases from St. Marylebone, Westminster, London ( Miles et al., in preparation) and St. Martin's Churchyard ( Mays et al., 2006a; Figure 5.12 ).
What is a wide, nonhealing fracture line known as?
Results in wide, nonhealing fracture lines known as Looser zones or Milkman lines
Which joints compensate for anterior bowing?
Anterior or posterior bowing may be compensated physiologically by hinge joints (knee/ankle)
Epidemiology
- Bowing fractures are almost exclusively found in children. However, there have been several case reports of bowing in adult bones. These injuries usually occur in children although adolescents may be affected. The radius and ulna are the most commonly affected bones, followed by the fibula. However, bowing fractures of all long bones have been desc...
Clinical Presentation
- Children present with pain and swelling following a fall, usually on an outstretched hand. This is often after falling from furniture or climbing equipment, especially monkey bars.
Pathology
- When an angulated longitudinal force is applied to a bone, the bone bends. Pediatric bones have a degree of elasticity and therefore, if the force is low and subsequently released, the bone returns to its normal position and no lasting evidence of that bowing is seen radiographically. This ability to bend occurs because the cortex is thinner in absolute and relative terms compared to adult b…
Radiographic Features
- On a plain film, bowing of the bone can be visualized provided that the view is in a different plane to the direction of bowing. If the view is in the plane of the bow, the bone may appear completely normal 1. The bowing tends to be fluid and blend into the normal bone at either end. There is no fracture line or visible cortical injury. There is usually an accompanying fracture of a paired bone…
Treatment and Prognosis
- Bowing fractures usually accompany another fracture and in those cases, treatment is determined according to the type and severity of the accompanying injury. In isolation, treatment of bowing fractures is debated 2. Some advocate the reduction of a bowing fracture where angulation exceeds 20 degrees. Most authors agree that where angulation is less than 20 degrees, manipul…
Differential Diagnosis