Orthopaedic Fixation Devices Used in Children: A Radiologist's Guide

Abstract

Fractures are common in children with some requiring surgical reduction and fixation to maintain anatomical alignment. Although various surgical techniques and principles are shared between children and adults, certain unique considerations in children can influence the surgical approach and device selection. In particular, for skeletally immature children, it is of utmost importance to protect certain critical open growth plates because permanent injury can produce severe growth disturbances. The often robust healing response and potential limited patient compliance can also influence the treatment algorithm and decision making. Commonly encountered orthopaedic fixation devices, including screws, intramedullary devices, and plates, are reviewed with an emphasis on their mechanism and application in children. Additional miscellaneous devices that are commonly used to treat malalignment and guide bone growth including epiphysiodesis plates, proximal femur osteotomy plates, and spinal magnetic growing rods are also reviewed. The goal of this article is to provide a basic understanding of the principles and mechanisms of different types of pediatric orthopaedic devices and thereby improve the radiologist's diagnostic confidence and allow better anticipation of complications.

Long-term Outcomes Following Free Vascularized Fibula Physeal Transfer for Proximal Humerus Oncologic Reconstruction in Children: An International Multi-Institutional Study

“…Our absolute indications to intervene in these patients with fractures included open and unstable fractures, or for unacceptable deformity. 18 The authors would agree that the recipient/ shoulder functional results following fibula transfer are quite impaired, and patients should be counseled that motion should not be expected to return to normal. Undoubtedly, this is mostly related to the extent of muscular cuff involvement in the cancer resection, and any motion postoperatively is mostly compensatory/scapulothoracic.…”

“…Our absolute indications to intervene in these patients with fractures included open and unstable fractures, or for unacceptable deformity. 18…”

“…The distal and proximal primary physes of long bones do not contribute equally to the overall lengthening of the bone. 18 In fact, 80% of the humeral growth is governed by the proximal epiphysis 18 ; therefore, reconstructing this portion of the UE is critical in cases following oncologic resection and limb salvage. The proximal fibula physis grows more rapidly than the distal physis and contributes more to the overall growth of the bone, 18 making it a good substitute for the proximal humerus defect as shown in this study.…”

“…18 In fact, 80% of the humeral growth is governed by the proximal epiphysis 18 ; therefore, reconstructing this portion of the UE is critical in cases following oncologic resection and limb salvage. The proximal fibula physis grows more rapidly than the distal physis and contributes more to the overall growth of the bone, 18 making it a good substitute for the proximal humerus defect as shown in this study. By calculating the total growth of the extremity (epiphysis to epiphysis), the total growth proximal to the hardware, and the length of the hardware, we were able to determine that the proximal construct including the transferred fibula (versus distal native extremity) was contributing to the majority of the total growth in the presented cases.…”

Return to Play in Youth Athletes: Role of the Radiologist with Focus on the Upper Extremity

“…In growing children, intramedullary devices and plates are often removed once the underlying fracture has fully or nearly completely healed, which usually takes 6 to 18 months. 29…”