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Fractures in Children

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In children Vs adult.

Growing skeleton.

Long bone Vs Short bone.

Springy bones.

Greenstick fracture.

Loose periosteum. Easy strip of periosteum by haematoma Callus.

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Site of FractureFore arm bone.

Supracondylar-Humerus.Lateral condyle-Humerus.

Epiphyseal injuries.

Spiral # - tibial shaft.

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 injuriesSalter & Harris classification(X-Ray):

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Ty

pe

Example Treatment Prognosis

I Radial neck epiphysisseparation

Closedreduction

Good

II Lower end radiusepiphysis

Closedreduction

Good

III Medial malleolus epiphysis Openreduction

Growthdisturbance

IV Lateral condyle ofhumerus

Openreduction

Growthdisturbance

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.

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Pathological #Infected bone.

Cysts.

Osteogenesis imperfecta.

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DiagnosisOften 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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DiagnosisLoss 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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TreatmentPlaster immobilization.

Traction.

Sling.

Surgery.

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Surgery for# NOF displaced.

# lateral condyle of the humerus (type IVepiphyseal injury).

# shaft of femur in older children.

Associated vascular injury.

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ComplicationsGrowth disturbances.

Brachial artery injury.

Myositis ossificans.

Avascular necrosis in # NOF.

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Thank U

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