1、Mamoun Kremli,Fractures in Children,1,Fractures in Children,Mamoun Kremli,Mamoun Kremli,Fractures in Children,2,General Principles,Immature skeleton differs from that of the adult in both the normal and pathological states. Capable of plastic deformation before they fail. Comminuted fractures are ra
2、re.,Mamoun Kremli,Fractures in Children,3,General Principles,Failure of union is rare. Few fractures require operative treatment. Presence of growth plate presents a challenge to the surgeon. Special considerations : Pathological fractures Child abuse,Mamoun Kremli,Fractures in Children,4,General Pr
3、inciples Development and Growth,A fracture in an immature bone can cause growth to speed up or slow down. Fractures heal very rapidly. Depending on the age of the child and direction of the deformity, can remodel with correction of most angular malunion. Most important area of injury is “physis”.,Ma
4、moun Kremli,Fractures in Children,5,General Principles Regulation of Epiphyseal Growth,Physis is the primary centre for growth in most bones. Four functional zones: Growth. Matrix. Transformation. Remodeling.,Mamoun Kremli,Fractures in Children,6,General Principles Regulation of Epiphyseal Growth,Ph
5、ysis responds to compression as well as distraction. Other stimuli to growth are insults from: Implants. Fractures. Infections. Repeated attempts at reduction.,Mamoun Kremli,Fractures in Children,7,General Principles Growth and Remodeling of the Metaphyseal Bone,Zone of transition between the physis
6、 and diaphysis. Site of most rapid changes in bone structure.,Mamoun Kremli,Fractures in Children,8,General Principles,Skeletal trauma accounts for 10-15 % of all childhood injuries Physeal disruptions make about 15 % of all skeletal injuries in children,Mamoun Kremli,Fractures in Children,9,Overall
7、 Frequency of Fractures,Percentage of children sustaining at least one fracture from 0 to16 years of age : Boys 42 % Girls 27 % Percentage of children sustaining a fracture in one year : 1.6 2.1 % Percentage of children who are hospitalized because of a fracture : During entire childhood (0 to 16 y)
8、 6.8 % Each year 0.43 %,Mamoun Kremli,Fractures in Children,10,Mamoun Kremli,Fractures in Children,11,Mamoun Kremli,Fractures in Children,12,General Principles Incidence of Fracture Type,In one study 30 % involved the physis. Of all physeal injuries, 50% occur in the distal radius. Second most commo
9、nly injured area is the distal humerus.,Mamoun Kremli,Fractures in Children,13,General Principles Incidence of Fracture Type,High energy trauma is the most common cause of death in children. Musculo-skeletal injuries are second to the CNS as the most frequent traumatic cause of permanent pediatric d
10、isability.,Mamoun Kremli,Fractures in Children,14,General Principles Clinical Examination of the Injured Child,Examination of the spine: 3% of all pediatric injuries. Incidence of spinal fractures is about 12% in postmortem examination of children who died from high energy trauma.,Mamoun Kremli,Frac
11、tures in Children,15,General Principles Clinical Examination of the Injured Child,Examination of the spine: Upper cervical spine is the most commonly injured area. Pain, torticollis, limitation of movement and muscle spasm raise the suspicion.,Mamoun Kremli,Fractures in Children,16,Examination of th
12、e pelvis: Most paediatric pelvic fractures are stable. Acetabular fractures represent 6% of pelvic fractures. Injury to triradiate cartilage can lead to growth arrest and dysplasia.,General Principles Clinical Examination of the Injured Child,Mamoun Kremli,Fractures in Children,17,Examination of the
13、 extremities: Examined systematically one by one from distal to proximal. Neurovascular examination. Limb should be splinted before x-ray, if child complains of pain.,General Principles Clinical Examination of the Injured Child,Mamoun Kremli,Fractures in Children,18,X-ray examination and other imagi
14、ng: AP and lateral. Comparison x-rays of the uninjured side help to evaluate growth plate injuries. CT for spine, pelvis and some intra-articular fractures.,General Principles Examination of the Injured Child,Mamoun Kremli,Fractures in Children,19,General Principles Xray Examination of the Injured C
15、hild,Law of Two-s : Two views Two joints Two limbs Two occasions Two physicians,Mamoun Kremli,Fractures in Children,20,General Principles Xray Examination of the Injured Child,Law of Two-s,Mamoun Kremli,Fractures in Children,21,General Principles Xray Examination of the Injured Child,Law of Two-s,Ma
16、moun Kremli,Fractures in Children,22,General Principles Xray Examination of the Injured Child,Law of Two-s,Periarticular and Articular Fractures ( Epiphyseal Injuries ),Mamoun Kremli,Fractures in Children,24,Periarticular and Articular Fractures General Principles and Classification,Inevitably invol
17、ve the growth plate. Treatment and prognosis depends upon the pattern of injury. Frequently used classification is Salter-Harris. Muller proposed classification based upon three subdivisions.,Mamoun Kremli,Fractures in Children,25,Periarticular and Articular Fractures Mullers Classification,Type A (
18、Salter-Harris Types I and II),Mamoun Kremli,Fractures in Children,26,Periarticular and Articular Fractures Mullers Classification,Type B (Salter-Harris Types III and IV),Mamoun Kremli,Fractures in Children,27,Periarticular and Articular Fractures Mullers Classification,Type C (Salter-Harris Type V):
19、,Mamoun Kremli,Fractures in Children,28,Epiphyseal Injuries,Mamoun Kremli,Fractures in Children,29,Epiphyseal Injuries,Mamoun Kremli,Fractures in Children,30,Epiphyseal Injuries,Mamoun Kremli,Fractures in Children,31,Epiphyseal Injuries,Mamoun Kremli,Fractures in Children,32,Epiphyseal Injuries,Mamo
20、un Kremli,Fractures in Children,33,Epiphyseal Injuries,Mamoun Kremli,Fractures in Children,34,Pathological Fractures,Bone Cyst,Mamoun Kremli,Fractures in Children,35,Pathological Fractures,Osteopetrosis,Mamoun Kremli,Fractures in Children,36,Pathological Fractures,Mamoun Kremli,Fractures in Children
21、,37,Supracondylar Fracture of Humerus Lateral X-rays,Mamoun Kremli,Fractures in Children,38,Radiological Evaluation of Elbow,Ant. fat pad Post. Fat pad Ant. Humeral line Radial head contour Radio-capitellar line Ossification centers Hourglass sign Distal humerus Ulna / olecranon Clinical correlation
22、,Mamoun Kremli,Fractures in Children,39,Radiological Evaluation of Elbow,Radio-capitellar line,Mamoun Kremli,Fractures in Children,40,Supracondylar Fracture of Humerus,Mamoun Kremli,Fractures in Children,41,Supracondylar Fracture of Humerus,Mamoun Kremli,Fractures in Children,42,Supracondylar Fractu
23、re of Humerus Closed Reduction,Mamoun Kremli,Fractures in Children,43,Supracondylar Fracture of Humerus Complications,Mamoun Kremli,Fractures in Children,44,Fracture of Lateral Humeral Condyle,Mamoun Kremli,Fractures in Children,45,Fracture of Lateral Humeral Condyle,Mamoun Kremli,Fractures in Child
24、ren,46,Fracture of Lateral Humeral Condyle,Mamoun Kremli,Fractures in Children,47,Fracture of Medial Humeral Condyle,Mamoun Kremli,Fractures in Children,48,Pulled Elbow,Mamoun Kremli,Fractures in Children,49,Special Considerations,Child Abuse,Mamoun Kremli,Fractures in Children,50,Torus Fracture,Mam
25、oun Kremli,Fractures in Children,51,Forearm Fractures,Mamoun Kremli,Fractures in Children,52,Closed Reduction of Forearm Fractures,Mamoun Kremli,Fractures in Children,53,Closed Reduction of Forearm Fractures,Mamoun Kremli,Fractures in Children,54,Forearm Fractures,Mamoun Kremli,Fractures in Children
26、,55,Unstable Forearm Fractures,Mamoun Kremli,Fractures in Children,56,Monteggia,Mamoun Kremli,Fractures in Children,57,Monteggia,Mamoun Kremli,Fractures in Children,58,Galleazzi,Mamoun Kremli,Fractures in Children,59,Unstable Reduction,Mamoun Kremli,Fractures in Children,60,Unstable Reduction,Mamoun Kremli,Fractures in Children,61,X-ray Quiz !,Mamoun Kremli,Fractures in Children,62,Toddlers Fracture,Mamoun Kremli,Fractures in Children,63,Referances,Mamoun Kremli,Fractures in Children,64,Mamoun Kremli,Thank You,
