BasicPrinciplesintheAssessmentandTreatmentofFracturesin.ppt

* * * Location Specific Pediatric Fracture Complications Complication Fracture Cubitus varus Supracondylar humerus fracture Volkmann’s ischemic contracture Supracondylar humerus fracture Refracture Femur fracture Mid-diaphyseal radius/ulna fractures Overgrowth Femur fracture (especially 5 years) Nonunion Lateral humeral condyle fracture Osteonecrosis Femoral neck fracture Talus fracture Progressive valgus Proximal tibia fractures Remodeling of Children’s Fractures Occurs by physeal periosteal growth changes Greater in younger children Greater if near a rapidly growing physis Treatment Principles Immobilization Time In general, physeal injuries heal in half the time it takes for nonphyseal fracture in the same region Healing time dependent on fracture location, displacement Stiffness from immobilization rare, thus err towards more time in cast if in doubt Remodeling of Children’s Fractures Not as reliable for: Midshaft angulation Older children Large angulation (20-30o) Will not remodel for: Rotational deformity Intraarticular deformity Remodeling more likely if: 2 years or more growth remaining Fractures near end of bone Angulation in plane of movement of adjacent joint 10 weeks post-injury 1 week post-injury Healing Salter I Distal Tibia Fracture Growth Arrest Secondary to Physeal Injury Complete cessation of longitudinal growth leads to limb length discrepancy Partial cessation of longitudinal growth angular deformity, if peripheral progressive shortening, if central Physes Susceptible to Growth Arrest Large cross sectional area Large growth potential Complex geometric anatomy Distal femur distal tibia, proximal tibia distal radius Growth Arrest Lines Transverse lines of Park- Harris Lines Occur after fracture/stress Result from temporary slowdown of normal longitudinal growth Thickened osseous plate in metaphysis Should parallel physis Growth Arrest Lines Appear 6-12 weeks after fracture Look for them in follow-up radiographs after fracture If parallel p