儿童骨骼生长及损伤特点.ppt - 浙江大学.ppt

There are two patterns of blood supply to epiphysis.Type A is … Tpye B is The other anatomic differences is the periosteum, the children’s periosteum is much thicker than the adults’ which produce callus more quickly. Now I will introduce the physiologic differences, the first is the Growth Remodeling because of the Asymmetric growth of physis and Wolff’s Law. The feature is most efficient in the younger children and in axis of rotation of adjacent joint. A 6-months boy with humerus fx get remodling after 6months A 9 years-old girl with femur fx fix with the beyonet position in the hip spica cast, 1 year later, the femur get complete remodling. The second is overgrowth, the feature leads to the LLD at last. Overgrowth is often occurs primarily in the long bone, Approximately 1~1.5cm in femur Fx and 7mm after tibia or humerus Fx The third is Progressive Deformity, the Permanent damage to growth plate lead to shortening and angular deformity It’s the case of the shortening deformity and Other case shows the angular deformity Biomechanical Differences is the Haversian canals occupy a greater portion of cortex in the child which result in the some special frature pattern The torus fracture is often occurs in the metaphyseal- diaphyseal junction in younger children The next is the Traumatic Bowing of Bone which most common in ulna and fibular can be bent 45°or more before fracture . We are familiar with the greenstick fracture, so I pass the section The last type is complete fracture. In children the fracture is rarely comminuted comparing to the adults. In children the Ligaments are Stronger than physis, so the epiphyseal separation is easily produced but the dislocation is rare. The physeal injury is commonly occurs in early adolescence but Uncommon in children younger than 5 years Salter-Harris Classification is very famous for the physeal injury In the type I, Germinal cells remain with epiphysis, so healing occur within 3 weeks and prognosis is generally exc