What is a pediatric plastic fracture?

Pediatric Plastic Fracture

A pediatric plastic fracture is a unique type of bone injury in children where the bone undergoes permanent bending or deformation without complete cortical disruption, resulting from the lower mineral content and greater elasticity of pediatric bones compared to adult bones. 1, 2

Characteristics of Plastic Fractures

• Plastic fractures represent acute plastic deformation of bone, most commonly seen in children due to their unique bone composition with lower mineral content than adult bone 2
• These fractures present with a bowing deformity that is evident both clinically and radiographically 3
• Unlike typical fractures, plastic fractures lack visible fracture lines on radiographs 3, 4
• They also do not demonstrate periosteal new bone formation during the healing phase, which is another distinguishing radiographic feature 3, 4

Common Sites and Mechanism

• The forearm is the most commonly affected site, though plastic deformation can occur in other long bones including the tibia 5, 4
• These injuries result from forces that would normally cause a complete fracture in adults but instead cause bending in children's more pliable bones 2
• The mechanism typically involves significant trauma that applies bending or torsional forces to the bone 5

Radiographic Features

• Broad fixed curvatures of the affected bone without visible fracture lines 4
• Absence of periosteal new bone formation following injury 3, 4
• May be associated with complete fractures of adjacent bones (e.g., plastic deformation of tibia with fibular fracture) 5

Treatment Challenges

• Plastic fractures often resist orthopedic reduction due to the fixed nature of the deformation 4
• Manipulative reduction frequently fails to correct the plastic curvature 4
• This can result in functional limitations, such as partial loss of pronation and supination in forearm injuries 4
• In younger children, partial correction may occur through cortical remodeling over time 4

Clinical Significance

• These fractures require regular follow-up until skeletal maturity to monitor for potential complications 5
• Understanding plastic fractures is important for proper diagnosis, as they may be mistaken for normal variants if the history of trauma is not considered 3
• The thick periosteum in children contributes to rapid fracture healing but may also maintain the deformed position 1

Potential Complications

• Malalignment that may persist if not properly managed 1
• Functional limitations depending on the location and severity of the deformation 4
• Unlike complete fractures, plastic deformations may not fully remodel with growth, especially in older children 4

Understanding the unique properties of pediatric bone is essential for properly identifying and managing plastic fractures, which represent an important subset of pediatric skeletal trauma with distinct treatment challenges.