Journal of Pain Management and Therapy

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Mini Review - Journal of Pain Management and Therapy (2023) Volume 7, Issue 6

A brief note on pathophysiology of pediatric orthopedic trauma.

Debi Michael*


Department of Pediatric Traumatology, Johannes Gutenberg University, Mainz, Germany

*Corresponding Author:
Debi Michael
Department of Pediatrics Traumatology
Johannes Gutenberg University
Mainz, Germany

Received:24-Oct-2023,Manuscript No. AAPMT-23-119433; Editor assigned: 26-Oct-2023, PreQC No. AAPMT-23-119433(PQ); Reviewed:09-Nov-2023, QC No. AAPMT-23-119433; Revised:14-Nov-2023, Manuscript No. AAPMT-23-119433(R); Published:21-Nov-2023, DOI: 10.35841/aapmt- 7.6.175

Citation: Elison L. A brief note on pediatric orthopedic emergency. J Pain Manage Ther. 2023;7(6):174

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This brief note provides an overview of the pathophysiology of pediatric orthopedic trauma, highlighting the unique considerations in understanding and managing musculoskeletal injuries in children. The article emphasizes the importance of recognizing growth plate vulnerability and age-related variability in injury patterns, ultimately contributing to effective diagnosis and treatment strategies.


Pediatric orthopedic trauma, a subset of orthopedic injuries that occur in children, presents a unique set of challenges for healthcare professionals. These injuries can range from simple fractures to complex multi-system traumas, and understanding their pathophysiology is crucial for effective management and treatment. In this article, we delve into the pathophysiology of pediatric orthopedic trauma, exploring the intricate mechanisms that underlie these injuries and the specific considerations when dealing with pediatric patients. The pathophysiology of pediatric orthopedic trauma begins with an understanding of the unique features of the pediatric musculoskeletal system. Children's bones are not simply smaller versions of adult bones; they are in a constant state of development. The growth plates, also known as epiphyseal plates, are crucial in bone development and are particularly vulnerable to injury in children. These plates are responsible for longitudinal bone growth, and trauma to this area can lead to deformities or growth disturbances[1].

Mechanisms of injury

Pediatric orthopedic trauma can result from various mechanisms, including falls, sports injuries, motor vehicle accidents, and non-accidental trauma (child abuse). Understanding the mechanisms of injury is essential for determining the type and extent of damage. The injury pattern often depends on the child's age, activity level, and the specific mechanism of trauma[2].

Fractures: Fractures are the most common form of pediatric orthopedic trauma. The pathophysiology of pediatric fractures is influenced by factors such as bone density, ligamentous laxity, and the unique biomechanical properties of growing bones. The two most prevalent types of fractures in children are greenstick and buckle fractures. Greenstick fractures occur when the bone bends but does not completely break, often due to the resilience of the periosteum. Buckle fractures involve compression of the bone, causing it to buckle without a complete break[3].

Growth plate injuries: Growth plate injuries are particularly significant in pediatric orthopedic trauma due to their potential long-term consequences. These injuries can lead to growth disturbances, which can result in limb length discrepancies, angular deformities, and functional limitations. The pathophysiology of growth plate injuries involves damage to the cartilage cells within the growth plate, potentially affecting bone growth. Proper diagnosis and treatment are essential to minimize the risk of long-term complications[4].

Soft tissue injuries: In addition to bone fractures and growth plate injuries, pediatric orthopedic trauma often involves soft tissue injuries. Ligamentous injuries, muscle strains, and joint dislocations can occur, and their pathophysiology may vary depending on the specific soft tissue involved. Ligaments and muscles in children may be more elastic and less resistant to injury, which necessitates careful evaluation and management.

Compartment syndrome: Compartment syndrome is a severe and potentially limb-threatening complication of orthopedic trauma. In children, compartment syndrome may be challenging to diagnose due to the limited ability of young patients to communicate their symptoms. The pathophysiology of compartment syndrome involves increased pressure within a closed muscular compartment, leading to compromised blood flow and tissue damage. Pediatric healthcare providers must be vigilant in assessing for signs of compartment syndrome to prevent severe complications[5].

Nerve injuries: Nerve injuries can accompany orthopedic trauma, and their pathophysiology is tied to the mechanism of injury. Depending on the location and severity of the injury, nerves can be compressed, stretched, or completely severed. Nerve injuries may result in sensory deficits, weakness, or paralysis, necessitating a comprehensive evaluation to determine the extent of damage and potential for recovery.

Vascular injuries: Vascular injuries are rare but can be life-threatening in pediatric orthopedic trauma. The pathophysiology of vascular injuries involves damage to blood vessels, leading to hemorrhage and reduced perfusion to the affected area. Prompt recognition and intervention are essential to prevent ischemia and its complications, which may include tissue necrosis and limb loss[6].

Considerations in pediatric patients

Pediatric orthopedic trauma management differs significantly from that of adults. Children's growing bodies require specialized care to ensure proper bone development and growth. When treating pediatric patients with orthopedic injuries, several considerations must be taken into account:

Growth plate protection: Preservation of growth plates is of paramount importance to prevent growth disturbances. Orthopedic surgeons must be adept at minimizing damage to these structures during surgery[7].

Age-related variability: The pathophysiology of injuries varies with age. Young children are more prone to ligamentous injuries, while older children may experience injuries more akin to adult patterns.

Fracture reduction and stabilization: Achieving stable fracture reduction is essential in pediatric orthopedic trauma to promote proper bone healing and growth. This may involve the use of casts, splints, or surgical fixation, depending on the injury[8].

Psychological support: Pediatric orthopedic trauma can be emotionally challenging for both the child and their family. Providing psychological support and involving pediatric psychologists or child life specialists can help children cope with the trauma and recovery process.

Multidisciplinary care: Pediatric orthopedic trauma management often requires a multidisciplinary approach, involving orthopedic surgeons, pediatricians, nurses, physical therapists, and other specialists to ensure comprehensive care[9].

Long-term consequences

Understanding the pathophysiology of pediatric orthopedic trauma is critical not only for immediate management but also for anticipating and addressing potential long-term consequences. Growth disturbances, joint contractures, and post-traumatic arthritis are just a few examples of potential complications that may arise as a result of inadequate management[10].


Pediatric orthopedic trauma is a complex and multifaceted field that demands a deep understanding of the unique pathophysiology of injuries in growing bodies. Children's bones are continually developing, and injuries must be managed with utmost care to prevent long-term complications. A comprehensive approach that considers the specific mechanisms of injury, the vulnerability of growth plates, and the psychological impact on pediatric patients is essential for effective treatment and optimal outcomes. By unraveling the pathophysiology of pediatric orthopedic trauma, healthcare professionals can better serve the needs of their young patients, ensuring a brighter and healthier future.


  1. Hogue GD, Wilkins KE, Kim IS. Management of pediatric tibial shaft fractures. Am Acad Orthop Surg. 2019;27(20):769-78.
  2. Indexed at, Google Scholar, Cross Ref

  3. Slongo T, Audige L, Schlickewei Wet al. Development and validation of the AO pediatric comprehensive classification of long bone fractures by the Pediatric Expert Group of the AO Foundation in collaboration with AO Clinical Investigation and Documentation and the International Association for Pediatric Traumatology. J Pediatr Orthop. 2006;26(1):43-9.
  4. Indexed at, Google Scholar, Cross Ref

  5. Vitale MG, Vitale MA, Lehmann CL, et al. Towards a national pediatric musculoskeletal trauma outcomes registry: The pediatric orthopaedic trauma outcomes research group (POTORG) experience. J Pediatr Orthop. 2006;26(2):151-6.
  6. Indexed at, Google Scholar, Cross Ref

  7. Della-Giustina K, Della-Giustina DA. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin North Am. 1999;17(4):895-922.
  8. Indexed at, Google Scholar, Cross Ref

  9. Mabrey JD, Fitch RD. Plastic deformation in pediatric fractures: Mechanism and treatment. J Pediatr Orthop. 1989;9(3):310-4.
  10. Indexed at, Google Scholar, Cross Ref

  11. Thornton MD, Della-Giustina K, Aronson PL. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin North Am. 2015;33(2):423-49.
  12. Indexed at, Google Scholar, Cross Ref

  13. Helenius I, Lamberg TS, Kaariainen S, et al. Operative treatment of fractures in children is increasing: A population-based study from Finland. J Bone Joint Surg Am. 2009;91(11):2612-6.
  14. Indexed at, Google Scholar, Cross Ref

  15. Hedström EM, Svensson O, Bergstrom U, et al. Epidemiology of fractures in children and adolescents: Increased incidence over the past decade: A population-based study from northern Sweden. Acta Orthop. 2010;81(1):148-53.
  16. Indexed at, Google Scholar, Cross Ref

  17. Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010;30(3):253-63.
  18. Indexed at, Google Scholar, Cross Ref

  19. Larson AN, Garg S, Weller A, et al. Operative treatment of type II supracondylar humerus fractures: does time to surgery affect complications? J Pediatr Orthop. 2014;34(4):382-7.
  20. Indexed at, Google Scholar, Cross Ref

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