wasupperextreme

Orthopedic Department
Center of Clinical Medicine-Rajavithi Hospital
& QSNICH, ICMDR
 Purpose

Common Fracture &dislocation in children

Fxnowepiphysis
Epiphyseal plate injury
Differences of fractures and dislocations in
child vs adult
Differences between child vs adult
elasticityno nudes

mainin
on
epiphysis

.Easier to occur Unison ji

non

: smaller in size aminoform

bone filmooo
gun

:less density of bone

 . Difficult to diagnose
two i xray
www.nmnounmain
di't
standard
incast Warn
wa periosteum un

Less corporations
Presence of growth plate
Presence of secondary
ossification centers
difference of x-ray
findings in different age
2nd ossification center + Vanvooren risotto
,

- Ñ In Ong

at least review
 xrayhealing
now 2months
calluschiusi

.Difference in treatment
:mostly can be treated nonoperatively
fixationin
o n ur
teint d d

.Faster to heal swanewhealing

into reductionsiniriasswhy
heal ininnbloodsupplyovens

:the older needs more time to heal

.Greater capacity to
remodel bone now Mariana
I

Arianna

Binda

nignonniormivininvonni

tibial
o
plats
fx mating

uniton
 iii
.Less incidence of
ligamentous injuries ,
joint dislocations and intra-
articular fractures
:less strength of growth
plate
 .Difference in complications

Less incidence of
nonunion in a minionrain
adult

fo nonunion
crow
delayunion

Less joint stiffness

 anadultnomaincomplete Iron
nun
comminute
transverse

.Difference in fracture patterns

Incomplete fracture
#plastic deformation
#greenstick fracture
bone Damn Dinos Ananta : . bone v. Vineeth
p bone doing

#Torus or Buckle
a. gun

Fractures dorsal
quin
cortex

Complete fracture
# Bayonet i complete fracture awww earning
nowrisusannan torn
bending

in
displace
reduction
atry
iron
 Epiphyseal plate injury
nWo

plate = physis
NDIVV 092

bone

longitudinal growth
charm Wwa
,

the immature bone

 Salter and Harris
Classification
I tryreduction

two tours type

complete
phasis tx
now iroi
displacenon dis x-ray Inno

d
in
intrarticon
extender
a compression

t
final diag ÑOMRI

mostcommon lesscommon
 Treatment

orcast
Type I & II-->Closed reduction +/- fixation nosin plate
growth

Type III &IV -->Operative Rx

Type V :Gentle reduction,Closed observation
,Surgical correction
compression
Supracondylar fracture
of Humerus
most common elbow injury (75%) Awvoronin

Q
peak incidence 5-8 year of age

.Extension Type (97%) distalfragment

2.Flexion Type (3%)

flexion ant humeral
an .

line

capitulum oefuii Ant

 iondynrAx
supra

Gartland Classification

Type I :non displaced or minimally displaced

Type II : displace but intact posterior cortex
Type III : totally displaced
 mygym
him cap
antiproton
cap .
 flexelbowwinor

Treatment
Indisplace in
Type I : long arm slab for 3 wks
common
an
reduction minibar
closed

Type II: CR +\-pinning apply long arm slab for 3 wks

totallyrdisplace
inn
Type III : CR+pinning+ long arm slab
innosern
:ORIF
 amedial
ino
sunulnar
minivan air
m
sires
amedia
I1st

mm
 Complications
Ian'smoreflexawwwcompressinjury

Nerve injury
Vascular injury
Cubitus varus
 Lateral condyle
Fracture of Humerus
the second most common (17%) of elbow injury
in children
:common missed diagnostic fracture win sinruins
onion
onion
c enter
osteotication

:may further displaced by extensor muscle

group
Classification

subtypes

invousamm
z amm
 Treatment
unsound

pinata
osteofication
pinon
epiph
area
phases

-2 mm -->Long arm cast 4wks ( FU every 3-5 days)

-4 mm -->Closed reduction and Percutaneous
pinning
>4 mm or rotated fragment-->ORIF
 Forearm Fraacture
Common fracture Ininnwinninin isartsunion

Fall on outstretching hand

Incidence proximal 5 % , shaft 15-25
%,distal 70-80 %
Associated elbow injury 13% : be careful
 Treatment film i it above
1 it Samir

Most of cases : Long arm cast

Older child : ORIF with plate & screw ,
9
intramedulary pin
n'lionize yr
 Long Arm Cast in Rx of
forearm fracture in children
ORIF Forearm Fracture
gender
Rev
 Femural Shaft Fracture
Axininn
rosinchildabuse inno

Common in children 5 bur

mu shaft
% fracture at diaphysis
Fracture in younger child ,Child abuse
has to be rule out
 A incomplete wirin

Treatment
complete

nounsnow

Depend on Age and Severity

Mostly treat by non-operative
fx femur on
Pavlik Harness → Iota 0-6 month

Hip spica cast 6m of

Flexible IM rod
ORIF c Plate & Screw
Younger Children (0-6 Mo)

flexhip flexknee
 Younger Children
hip spica cast
are
.

flexureHerm
narrow

I
Novosiuirinin

honour wanna Eisner

Older Children

sin
holdfr
No

innit