Paed Fracture

Fractures in Children

03/21/09

C.B.SENTHILKUMAR

1

In children Vs adult. Growing skeleton. 

Long bone Vs Short bone.

Springy bones. 

Greenstick fracture.

Loose periosteum. 

03/21/09

Easy strip of periosteum by haematoma  Callus.

C.B.SENTHILKUMAR

2

Site of Fracture Fore arm bone. Supracondylar-Humerus. Lateral condyle-Humerus. Epiphyseal injuries. Spiral # - tibial shaft. 

03/21/09

Uncommon: Dislocation & # hands & feet.

C.B.SENTHILKUMAR

3

Healing of # : Half the time of adults. Remodelling : All evidence of past #  missing  after few months. Potential varies with ; Age.  Location.  Degree & Type of angulation. 

03/21/09

C.B.SENTHILKUMAR

4

Types of # Birth # & related injuries. Epiphyseal injuries. Long bone – shaft. Pathological #.

03/21/09

C.B.SENTHILKUMAR

5

Birth # # or epiphyseal separation sustained during a

difficulty delivery. Multiple # associated with congenital fragility

of bones. Eg:- osteogenesis imperfecta. Pseudoarthrosis of Tibia.

03/21/09

C.B.SENTHILKUMAR

6

Epiphyseal injuries Salter & Harris classification(X-Ray): Ty pe

Example

Treatment

Prognosis

I

Radial neck epiphysis separation

Closed reduction

Good

II

Lower end radius epiphysis

Closed reduction

Good

III

Medial malleolus epiphysis Open reduction

Growth disturbance

IV

Lateral condyle of humerus

Open reduction

Growth disturbance

V

Lower tibial epiphyseal injury.

conservative

Growth disturbance

03/21/09

C.B.SENTHILKUMAR

7

03/21/09

C.B.SENTHILKUMAR

8

Shaft # Displacement is less – Inner cortex bends ;

outer cortex breaks. Mal-alignment corrected with growth. Faster union of #. Treatment – conservative > surgery. 03/21/09

C.B.SENTHILKUMAR

9

Pathological # Infected bone. Cysts. Osteogenesis imperfecta.

03/21/09

C.B.SENTHILKUMAR

10

Diagnosis Often missed by reasons of History of trauma. More dramatic signs may be absent. Parents attempt to conceal the injury. Undisplaced # missed on an X ray.

03/21/09

C.B.SENTHILKUMAR

11

Diagnosis Loss of function. Unwillingness to use a limb associated with

local pain and tenderness. Episode of trauma.

03/21/09

C.B.SENTHILKUMAR

12

Physical Examination.

X Ray.

03/21/09

C.B.SENTHILKUMAR

13

03/21/09

C.B.SENTHILKUMAR

14

Treatment Plaster immobilization. Traction. Sling. Surgery.

03/21/09

C.B.SENTHILKUMAR

15

Surgery for # NOF displaced. # lateral condyle of the humerus (type IV

epiphyseal injury). # shaft of femur in older children. Associated vascular injury.

03/21/09

C.B.SENTHILKUMAR

16

Complications Growth disturbances. Brachial artery injury. Myositis ossificans. Avascular necrosis in # NOF.

03/21/09

C.B.SENTHILKUMAR

17

Thank U

03/21/09

C.B.SENTHILKUMAR

18