Metaphyseal bucket handle or corner fractures result from pulling or twisting an extremity suddenly and forcibly. We found that the diagnosis of distal humeral epiphyseal separation is often missed on radiographs. In the six 38% patients younger than 1 month, distal humeral epiphyseal separation was secondary to birth trauma. Proximal humerus fractures, when the fracture site is near the shoulder. Inclusion of the subperiosteal bone collar within the peripheral portion of the metaphyseal fracture fragment explains the radiographic appearance of. A corner fracture refers to injury of the metaphysis, or the growing plate at either end of long bones, such as the femur and tibia. Historically, the treatment of choice has been functional bracing. Can classic metaphyseal lesions follow uncomplicated.
A humerus fracture is the medical term for a break in the bone of the upper arm. Are bucket handle fractures the same as corner fractures. Pdf metaphyseal corner fractures mcfs in infants are strongly associated with inflicted injuries. This injury is not only the fracture most specific for nai, it is also common among abused children, occurring in 50% range 3959%. Thefemur, humerus,andtibiaarethe most common long bones to be in. We report the case of an otherwise healthy 18monthold child, who presented to the emergency room with bilateral humeral shaft and corner fractures. Distal humeral epiphyseal separation in young children. In another patient 5 it was identified only with ultrasound.
Physeal injuries have been reported at the proximal and distal humerus, femur, and tibia. Bucket handle fracture definition of bucket handle. Femur fracture in child non operative phase i weeks dates. Upper extremity fractures generally occur with a fall onto an outstretched arm. The periphery of the fracture extends obliquely toward the diaphysis creating a triangular fragment corner fracture whereas the central portion of the fracture extends toward the physis resulting in a thin fragment bucket handle. This action causes separation of a peripheral metaphyseal bone fragment with attached subpereostal bone collar, forming a mobile concave disk shaped bone fragment. There are several types of humerus fractures, depending on the location of the break. Pdf metaphyseal corner fracture caused in utero by.
The terms corner fracture and bucket handle fracture describe fractures at the metaphyses of the long bones that are highly specific for nonaccidental trauma, since nonambulatory children cannot inflict this type of injury on themselves box 18. B a buckethandle fracture of the distal humerus and laminar periosteal reaction are present in this 5 week old infant. A corner fracture gets the name bucket handle fracture from the shape of the injury. Evaluating children with fractures for child physical abuse abstract fractures are common injuries caused by child abuse.
A humerus fracture is a break in the large bone of your upper arm. Metaphyseal corner fractures, also known as classical metaphyseal lesions cml or bucket handle fractures, are observed in young children, less than 2 years old. Understanding what buckle fractures are in children. Nonaccidental trauma nat in pediatric patients orthopaedic. Anatomy proximally, the humerus is roughly cylindrical in cross section, tapering to a triangular shape distally. These are the types of nonoperative ways to handle a humerus fracture cast. A surgical neck fracture happens when the humerus is forced in one direction, and the joint capsule and rotator cuff muscles remain intact.
The humerus is well enveloped in muscle and soft tissue, hence there is a good prognosis for healing in the majority of uncomplicated fractures. The classic metaphyseal lesion is also referred to as a corner fracture or a bucket handle fracture. The metaphysis is a piece of cartilage in children, not yet a fully ossified bone. The pathognomonic fracture related to child abuse is the corner or buckethandle fracture of the metaphysis.
Depending on how it is viewed, the fracture may appear as a corner injury or as a buckethandle fracture. A distal humerus fracture is a break in the lower end of the upper arm bone humerus, one of the three bones that come together to form the elbow joint. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. Rib fractures are strongly associated with child abuse in infancy. The upper extremity radiograph shows a transverse fracture of the midportion of the shaft of the left humerus. Corner fractures and bucket handle fractures are similar in etiology despite their different names.
Transverse fractures result from a direct impact to the bone. A patients guide to adult humerus shaft fractures compliments of. In 10 of 16 patients 63%, one or more associated distal humeral fractures were identified. The medullary canal of the humerus tapers to an end above the supracondylar expansion. If the fracture is an open fracture also called a compound fracture surgery will be necessary. Pdf metaphyseal corner fracture caused in utero by external. Hay, a pediatric radiologist at childrens hospital in denver, said fractures of a childs growth plates at the ends of the bones can occur because they are a weaker part of the bone. Because children have softer, more flexible bones, one side of the bone may buckle upon itself without disrupting the other side of the bonealso known as an incomplete fracture and cause symptoms. The prognosis is favourable across fracture types and circumstances of occurrence. The wrist may be tender, slightly swollen, and painful to move. The humerus is the long bone that runs from your shoulder to your elbow. Clinical report evaluating children with fractures for. Physeal injuries have been reported at the proximal and distal humerus, femur.
Many are associated with head injuries, soft tissue injuries, burns, abdominal injuries, and genital injuries. I was in rocking chair with baby 3 1\2 months was he facing me on the floor on his tummy and i was reaching down to put binky in his mouth and the chair fell forward landing on me and my son. The term buckethandle fracture is used where the loose bone is rather wide at the distal end, making it end in a crescent shape. L, fractura, break a fracture of the wider end of a long bone along the growth plate forming an arc along the proximal margin. A buckle fracture, also called a torus fracture, is an extremely common injury seen in children. A proximal humerus fracture is when the bone is broken at or near the top, by the shoulder. Distal humerus fractures of the elbow orthoinfo aaos. A fracture in this area can be very painful and make elbow motion difficult or impossible.
Distinguishing child abuse fractures from rickets springerlink. Humerus fracture broken upper arm orthopedic medical. The indicated bucket handle fragment is more sharply defined than the healing zone of provisional calcification of fig. Bucket handle fracture advanced radiology teaching. Most bucket handle fractures occur in the distal femur, proximal tibia, distal tibia, and proximal humerus. If a fracture or fracture repair is stable, then therapy should be started early. New bone formation leads to a thickened appearance and simulates the appearance of a handle.
This injury is treated by wearing a removable back slab or readymade splint figure 2 which can be removed. An open fracture occurs when there is a laceration through the skin that connects to the fracture. A proximal humerus fracture usually occurs close to the shoulder joint and can be located at. Child abuse fractures musculoskeletal medicine for. The presence of a buckethandle fracture of the distal humerus is commonly associated with distal humeral epiphyseal separation and may not indicate nonaccidental trauma. Humerus, proximal, articular fracture impacted with marked displacement 11c2 1. A subacute metaphyseal fracture can form a long arc along the proximal margin of the growing. Midshaft humerus fractures, when the fracture occurs away from the. Discussion the first case of nonaccidental trauma was described by john caffey in an infant with multiple fractures and bilateral subdural hematomas in 1946.
Humeral fractures can be classified into three types, depending on which part of the bone is broken. The pain may subside if the injured limb is protected. Diaphyseal fractures are more common than metaphyseal fractures with inflicted trauma, but less specific. Pdf bilateral humerus and corner fractures in an 18monthold. The fracture occurs between the zone of calcified cartilage and the primary spongiosa. The most useful rehabilitation protocol is the threephase system. A corner fracture is the culmination of multiple small fractures microfractures across the metaphysis, positioned perpendicularly to the long axis of the bone. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Bucket handle fracture was identified in five of 16 patients 31%. I recently fractured my left humerus and found that reading humerus fracture recovery blogs has been helpful in anticipating the healing process. Fractures in children younger than 18 months occur before the usual walking age. Metaphyseal corner fracture radiology reference article. This is when the proximal humerus is broken into three. Buckle injuries of the wrist a buckle injury of the wrist is a small area of compressed bone figure 1.
Other names for a corner fracture are a buckethandle fracture or metaphyseal fracture. In particular, bucket handle fractures classic metaphyseal lesions at. Humerus fracture upper arm fracture johns hopkins medicine. My baby got bucket handle fractures of the legsankles everything i read about this type fracture leads to abuse however the same week before we found out. This uses the weight of the arm and cast in order to keep the humerus reduced. Fractures of the humerus are classified in one of two ways. Bucket handle fracture joseph junewick, md facr 02262009 history 9 month old female with multiple fractures. A cml occurs when a torsional force is applied to the immature primary spongiosa adjacent to a cartilaginous growth plate. The bucket handle fracture is virtually pathognomotic of inflicted injury and is related to shearing forces generated by rapid accelerationdeceleration or torsion.
Like the femur, the treatment of humerus fractures depends upon the fracture location and pattern. Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. Proximal humerus fracture book twin cities orthopedics. The humerus also known as the upper arm bone is a long bone that runs from the shoulder and scapula shoulder blade to the elbow. Among a total of 34 519 live births, 8 neonates had a longbone fracture incidence 0. Buckle injuries of the wrist royal childrens hospital. Corner or buckethandle fractures in children signs of. Fractures in children younger than 18 months sciencedirect. In two patients 7 and 8 the fracture was identified only on radiographs.
The fractures result from tractional and torsional force applied to an extremity and. Transcephalic double profile image on xray and tubercular, with varus malalignment 11c2. A corner fracture or buckethandle fracture is fragmentation of the distal end of one or both femurs, with the loose piece appearing at the bone margins as an osseous density paralleling the metaphysis. Other injuries that are highly specific to child abuse are posterior rib fractures see the image below and fractures of the scapula, spinous process, and sternum, because these bones are ordinarily difficult to break. Spiral injuries also can be caused by child abuse when the lesional mechanism is caused by torsion. In 4 of the 10 40% older patients, nonaccidental trauma was diagnosed.
The humerus is the long bone that sits between the shoulder and the elbow. The humerus fracture needs to be acceptably reduced in a relatively normal position in order to be treated nonoperatively. The humerus is most frequently fractured as the result of a fall or motor vehicle crash. Fragility fractures of the proximal humerus commonly occur at the metaphysis, or surgical neck, of the humerus and are impacted and minimally displaced. In addition to the fractures displayed above, this patient also has a small bucket handle fracture of the distal humeral metaphysis and a small bucket handle fracture of the distal tibia.
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