fractures ksu小儿骨折堪萨斯州立大学课件

Fractures in ChildrenFractures in Children Mamoun Kremli 1 General Principles nImmature skeleton differs from that of the adult in both the normal and pathological states. nCapable of plastic deformation before they fail. nComminuted fractures are rare. 2 General Principles nFailure of union is rare. nFew fractures require operative treatment. nPresence of growth plate presents a challenge to the surgeon. nSpecial considerations : uPathological fractures uChild abuse 3 General Principles Development and Growth nA fracture in an immature bone can cause growth to speed up or slow down. nFractures heal very rapidly. nDepending on the age of the child and direction of the deformity, can remodel with correction of most angular malunion. nMost important area of injury is “physis”. 4 General Principles Regulation of Epiphyseal Growth nPhysis is the primary centre for growth in most bones. nFour functional zones: uGrowth. uMatrix. uTransformation. uRemodeling. 5 General Principles Regulation of Epiphyseal Growth nPhysis responds to compression as well as distraction. nOther stimuli to growth are insults from: uImplants. uFractures. uInfections. uRepeated attempts at reduction. 6 General Principles Growth and Remodeling of the Metaphyseal Bone nZone of transition between the physis and diaphysis. nSite of most rapid changes in bone structure. 7 General Principles nSkeletal trauma accounts for 10-15 % of all childhood injuries nPhyseal disruptions make about 15 % of all skeletal injuries in children 8 Overall Frequency of Fractures nPercentage of children sustaining at least one fracture from 0 to16 years of age : uBoys 42 % uGirls 27 % nPercentage of children sustaining a fracture in one year : 1.6 2.1 % nPercentage of children who are hospitalized because of a fracture : uDuring entire childhood (0 to 16 y) 6.8 % uEach year 0.43 % 9 10 11 General Principles Incidence of Fracture Type nIn one study 30 % involved the physis. nOf all physeal injuries, 50% occur in the distal radius. nSecond most commonly injured area is the distal humerus. 12 General Principles Incidence of Fracture Type nHigh energy trauma is the most common cause of death in children. nMusculo-skeletal injuries are second to the CNS as the most frequent traumatic cause of permanent pediatric disability. 13 General Principles Clinical Examination of the Injured Child nExamination of the spine: u3% of all pediatric injuries. uIncidence of spinal fractures is about 12% in postmortem examination of children who died from high energy trauma. 14 General Principles Clinical Examination of the Injured Child nExamination of the spine: uUpper cervical spine is the most commonly injured area. uPain, torticollis, limitation of movement and muscle spasm raise the suspicion. 15 nExamination of the pelvis: uMost paediatric pelvic fractures are stable. uAcetabular fractures represent 6% of pelvic fractures. uInjury to triradiate cartilage can lead to growth arrest and dysplasia. General Principles Clinical Examination of the Injured Child 16 nExamination of the extremities: uExamined systematically one by one from distal to proximal. uNeurovascular examination. uLimb should be splinted before x-ray, if child complains of pain. General Principles Clinical Examination of the Injured Child 17 nX-ray examination and other imaging: uAP and lateral. uComparison x-rays of the uninjured side help to evaluate growth plate injuries. uCT for spine, pelvis and some intra- articular fractures. General Principles Examination of the Injured Child 18 General Principles Xray Examination of the Injured Child nLaw of Two-s : uTwo views uTwo joints uTwo limbs uTwo occasions uTwo physicians 19 General Principles Xray Examination of the Injured Child Law of Two-s 20 General Principles Xray Examination of the Injured Child Law of Two-s 21 General Principles Xray Examination of the Injured Child Law of Two-s 22 PeriarticularPeriarticular and and Articular FracturesArticular Fractures ( ( EpiphysealEpiphyseal Injuries ) Injuries ) 23 Periarticular and Articular Fractures General Principles and Classification nInevitably involve the growth plate. nTreatment and prognosis depends upon the pattern of injury. nFrequently used classification is Salter- Harris. nMuller proposed classification based upon three subdivisions. 24 Periarticular and Articular Fractures Mullers Classification Type A (Salter-Harris Types I and II) 25 Periarticular and Articular Fractures Mullers Classification Type B (Salter-Harris Types III and IV) 26 Periarticular and Articular Fractures Mullers Classification nType C (Salter-Harris Type V): 27 Epiphyseal Injuries 28 Epiphyseal Injuries 29 Epiphyseal Injuries 30 Epiphyseal Injuries 31 Epiphyseal Injuries 32 Epiphyseal Injuries 33 Pathological Fractures Bone Cyst 34 Pathological Fractures Osteopetrosis 35 Pathological Fractures 36 Supracondylar Fracture of Humerus Lateral X-rays 37 Radiological Evaluation of Elbow nAnt. fat pad nPost. Fat pad nAnt. Humeral line nRadial head contour nRadio-capitellar line nOssification centers nHourglass sign nDistal humerus nUlna / olecranon nClinical correlation 38 Radiological Evaluation of Elbow Radio-capitellar line 39 Supracondylar Fracture of Humerus 40 Supracondylar Fracture of Humerus 41 Supracondylar Fracture of Humerus Closed Reduction 42 Supracondylar Fracture of Humerus Complications 43 Fracture of Lateral Humeral Condyle 44 Fracture of Lateral Humeral Condyle 45 Fracture of Lateral Humeral Condyle 46 Fracture of Medial Humeral Condyle 47 Pulled Elbow 48 Special Considerations 49 Torus Fracture