Pediatric Trauma: An Introduction

Most fractures in skeletally immature patients can be successfully treated conservatively by closed reduction and cast application. In some cases, however, open reduction and stabilization of the fracture with various techniques may be necessary, including K-wires, elastic nails, standard plates, or locking pediatric plates. The use of standard external fixators (that do not allow gradual correction of deformities) may be indicated in the management of open fractures, fractures with bone loss, comminuted fractures, certain metaphyseal and physeal injuries, infected fractures, polytrauma patients, and those with head injuries. In such cases, the use of standard external fixation is usually temporary and is typically converted to other methods of stabilization once the condition permits. On the other hand, in some specific conditions, the use of external fixation that allows deformity correction is indicated. The advantages of these fixators over other modalities of treatment, include functional use of the limb and weight bearing during the whole period of treatment, access to the fracture site for treatment of soft tissues, correction of any type and any amount of deformity (acutely or gradually), and the possibility of lengthening in cases of bone shortening (Table 1).