Fractures in Children
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C.B.SENTHILKUMAR
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In children Vs adult. Growing skeleton.
Long bone Vs Short bone.
Springy bones.
Greenstick fracture.
Loose periosteum.
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Easy strip of periosteum by haematoma Callus.
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Site of Fracture Fore arm bone. Supracondylar-Humerus. Lateral condyle-Humerus. Epiphyseal injuries. Spiral # - tibial shaft.
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Uncommon: Dislocation & # hands & feet.
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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.
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Types of # Birth # & related injuries. Epiphyseal injuries. Long bone – shaft. Pathological #.
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Birth # # or epiphyseal separation sustained during a
difficulty delivery. Multiple # associated with congenital fragility
of bones. Eg:- osteogenesis imperfecta. Pseudoarthrosis of Tibia.
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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
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Shaft # Displacement is less – Inner cortex bends ;
outer cortex breaks. Mal-alignment corrected with growth. Faster union of #. Treatment – conservative > surgery. 03/21/09
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Pathological # Infected bone. Cysts. Osteogenesis imperfecta.
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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.
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Diagnosis Loss of function. Unwillingness to use a limb associated with
local pain and tenderness. Episode of trauma.
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Physical Examination.
X Ray.
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Treatment Plaster immobilization. Traction. Sling. Surgery.
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Surgery for # NOF displaced. # lateral condyle of the humerus (type IV
epiphyseal injury). # shaft of femur in older children. Associated vascular injury.
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Complications Growth disturbances. Brachial artery injury. Myositis ossificans. Avascular necrosis in # NOF.
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Thank U
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