Children have a unique ability for healing of their fractures
and remodeling of their deformities. The physician should strive to achieve
anatomic reduction of fractures in children.
The surgeon may not be able to achieve acceptable reduction every
time, fractures do not always remodel. The deformity may lead to unacceptable
results in cosmesis and function.
What are the rules for remodeling in children?
Age of the patient:
Younger children have better remodeling potential. The
younger, the better. Children with two or more years of growth left have a
chance for remodeling. The periosteum in children is thick and promotes faster
healing of the fracture as well as increased potential for remodeling.
Distance:
The distance of the fracture from the end of the bone.
Fracture in the metaphysis remodels better than in the middle of the bone. A fracture
in the middle of the bone has less potential for remodeling.
Severity of
Angulation
If there is minimal angulation, the bone could remodel
completely. Where angulation is more severe, the bone will partially remodel.
Angulation in the plane of joint movement is most likely to improve with growth
and remodeling.
Remodeling will not improve displaced fractures involving
the joint or the growth plate.
